Provider Demographics
NPI:1154707081
Name:MAHROUS, RAMY
Entity type:Individual
Prefix:
First Name:RAMY
Middle Name:
Last Name:MAHROUS
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 1:31 PALOMBA DR
Mailing Address - Street 2:UNIT 301
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06083-7701
Mailing Address - Country:US
Mailing Address - Phone:860-230-7688
Mailing Address - Fax:
Practice Address - Street 1:3265 BERLIN TPKE
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-5101
Practice Address - Country:US
Practice Address - Phone:860-616-0023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0013113183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist