Provider Demographics
NPI:1063986735
Name:ABUSALIH, SHAHUL
Entity type:Individual
Prefix:
First Name:SHAHUL
Middle Name:
Last Name:ABUSALIH
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 1:3312 CIRCLE BROOK DR APT D
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24018-8231
Mailing Address - Country:US
Mailing Address - Phone:717-590-0940
Mailing Address - Fax:
Practice Address - Street 1:5201 SPRING RD STE 6
Practice Address - Street 2:
Practice Address - City:SHERMANS DALE
Practice Address - State:PA
Practice Address - Zip Code:17090-8582
Practice Address - Country:US
Practice Address - Phone:717-582-7781
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP452920183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist