Provider Demographics
NPI:1366218968
Name:ABU QURA, MOHD AMIN
Entity type:Individual
Prefix:
First Name:MOHD AMIN
Middle Name:
Last Name:ABU QURA
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 1:3250 N JOHN YOUNG PKWY
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-7549
Mailing Address - Country:US
Mailing Address - Phone:407-933-0947
Mailing Address - Fax:407-933-1776
Practice Address - Street 1:3250 N JOHN YOUNG PKWY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-7549
Practice Address - Country:US
Practice Address - Phone:407-933-0947
Practice Address - Fax:407-933-1776
Is Sole Proprietor?:No
Enumeration Date:2023-11-27
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS66563183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist