Provider Demographics
NPI:1366057952
Name:HASNAIN, MOHAMMED HUMZA
Entity type:Individual
Prefix:DR
First Name:MOHAMMED
Middle Name:HUMZA
Last Name:HASNAIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8235 COPPERCREEK DR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-6822
Mailing Address - Country:US
Mailing Address - Phone:317-796-6165
Mailing Address - Fax:
Practice Address - Street 1:3600 FERN VALLEY RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40219-1917
Practice Address - Country:US
Practice Address - Phone:502-964-7114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-10
Last Update Date:2020-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN45020588A183500000X
KYI13205183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist