Provider Demographics
NPI:1316267636
Name:SHALABY, EMAD A
Entity type:Individual
Prefix:
First Name:EMAD
Middle Name:A
Last Name:SHALABY
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 1:7224 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LEMON GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:91945-1501
Mailing Address - Country:US
Mailing Address - Phone:619-465-6694
Mailing Address - Fax:619-465-1583
Practice Address - Street 1:7224 BROADWAY
Practice Address - Street 2:
Practice Address - City:LEMON GROVE
Practice Address - State:CA
Practice Address - Zip Code:91945-1501
Practice Address - Country:US
Practice Address - Phone:619-465-6694
Practice Address - Fax:619-465-1583
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-09
Last Update Date:2010-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47690183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist