Provider Demographics
NPI:1427858927
Name:MOUSTAFA, MOHANAD N
Entity type:Individual
Prefix:
First Name:MOHANAD
Middle Name:N
Last Name:MOUSTAFA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1124 COLUMBUS AVE APT 12
Mailing Address - Street 2:
Mailing Address - City:LEMOYNE
Mailing Address - State:PA
Mailing Address - Zip Code:17043-1727
Mailing Address - Country:US
Mailing Address - Phone:321-338-5790
Mailing Address - Fax:
Practice Address - Street 1:1137 MARKET ST
Practice Address - Street 2:
Practice Address - City:LEMOYNE
Practice Address - State:PA
Practice Address - Zip Code:17043-1416
Practice Address - Country:US
Practice Address - Phone:717-737-3359
Practice Address - Fax:717-737-9665
Is Sole Proprietor?:No
Enumeration Date:2025-03-14
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP459223183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist