Provider Demographics
NPI:1033836663
Name:SHENOUDA PHARMACY INC
Entity Type:Organization
Organization Name:SHENOUDA PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NAGEH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHENOUDA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:508-667-2489
Mailing Address - Street 1:26 ARNOLD ST
Mailing Address - Street 2:
Mailing Address - City:FEEDING HILLS
Mailing Address - State:MA
Mailing Address - Zip Code:01030-1902
Mailing Address - Country:US
Mailing Address - Phone:508-667-2489
Mailing Address - Fax:
Practice Address - Street 1:635 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01020-3047
Practice Address - Country:US
Practice Address - Phone:508-667-2489
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy