Provider Demographics
NPI:1003493503
Name:ELBASHIR, SUHA AHMED ELHAJ
Entity Type:Individual
Prefix:
First Name:SUHA
Middle Name:AHMED ELHAJ
Last Name:ELBASHIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2080 E ROXBORO RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-2740
Mailing Address - Country:US
Mailing Address - Phone:256-479-1434
Mailing Address - Fax:
Practice Address - Street 1:2080 E ROXBORO RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-2740
Practice Address - Country:US
Practice Address - Phone:256-479-1434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-29
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH032627183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist