Provider Demographics
NPI:1063153419
Name:NUWAYHID, MAZEN ROBERT (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MAZEN
Middle Name:ROBERT
Last Name:NUWAYHID
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6046 HIGHWAY 53
Mailing Address - Street 2:
Mailing Address - City:HARVEST
Mailing Address - State:AL
Mailing Address - Zip Code:35749-9538
Mailing Address - Country:US
Mailing Address - Phone:256-858-9677
Mailing Address - Fax:256-517-9319
Practice Address - Street 1:6046 HIGHWAY 53
Practice Address - Street 2:
Practice Address - City:HARVEST
Practice Address - State:AL
Practice Address - Zip Code:35749-9538
Practice Address - Country:US
Practice Address - Phone:256-858-9677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-07
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14420183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100003084Medicaid