Provider Demographics
NPI:1306352968
Name:SHABANA, MOHAMED H
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:H
Last Name:SHABANA
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 1:1406A RIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-2914
Mailing Address - Country:US
Mailing Address - Phone:267-519-3387
Mailing Address - Fax:
Practice Address - Street 1:1406A RIDGE AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19130-2914
Practice Address - Country:US
Practice Address - Phone:267-519-3387
Practice Address - Fax:267-519-3429
Is Sole Proprietor?:No
Enumeration Date:2017-12-19
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP449124183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist