Provider Demographics
NPI:1386420677
Name:MEGALA, ABANOUB MICHAEL SHAFIK
Entity type:Individual
Prefix:
First Name:ABANOUB
Middle Name:MICHAEL SHAFIK
Last Name:MEGALA
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 1:12550 DEER CREEK DR APT 206
Mailing Address - Street 2:
Mailing Address - City:NORTH ROYALTON
Mailing Address - State:OH
Mailing Address - Zip Code:44133-6723
Mailing Address - Country:US
Mailing Address - Phone:440-870-1282
Mailing Address - Fax:
Practice Address - Street 1:207 N COURT ST
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-1963
Practice Address - Country:US
Practice Address - Phone:330-725-4104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-04
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03443448183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist