Provider Demographics
NPI:1841957420
Name:ELSAYED, AHMED S (RPH)
Entity type:Individual
Prefix:
First Name:AHMED
Middle Name:S
Last Name:ELSAYED
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4224 W HAWTHORNE TRACE RD APT 204
Mailing Address - Street 2:
Mailing Address - City:BROWN DEER
Mailing Address - State:WI
Mailing Address - Zip Code:53209-1025
Mailing Address - Country:US
Mailing Address - Phone:470-331-1493
Mailing Address - Fax:
Practice Address - Street 1:152 WASHINGTON AVE
Practice Address - Street 2:STORE #8775
Practice Address - City:CEDARBURG
Practice Address - State:WI
Practice Address - Zip Code:53012
Practice Address - Country:US
Practice Address - Phone:262-377-6090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21192-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist