Provider Demographics
NPI:1982943114
Name:MANSOUR-AWAD, AMANY FARID (RPH)
Entity type:Individual
Prefix:
First Name:AMANY
Middle Name:FARID
Last Name:MANSOUR-AWAD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 SPRUCE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5752
Mailing Address - Country:US
Mailing Address - Phone:855-790-0100
Mailing Address - Fax:267-861-0862
Practice Address - Street 1:829 SPRUCE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5752
Practice Address - Country:US
Practice Address - Phone:855-790-0100
Practice Address - Fax:267-861-0862
Is Sole Proprietor?:No
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP038763L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist