Provider Demographics
NPI:1386067536
Name:ELBEHERY, MAHMOUD
Entity type:Individual
Prefix:
First Name:MAHMOUD
Middle Name:
Last Name:ELBEHERY
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 1:1462 S PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85365-1733
Mailing Address - Country:US
Mailing Address - Phone:928-783-6575
Mailing Address - Fax:
Practice Address - Street 1:1462 S PACIFIC AVE
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85365-1733
Practice Address - Country:US
Practice Address - Phone:321-368-8351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS017005183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist