Provider Demographics
NPI:1043526908
Name:ABDELFATTAH, ELSHAMLY AFFAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:ELSHAMLY
Middle Name:AFFAN
Last Name:ABDELFATTAH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:PROF
Other - First Name:ELSHAMLY
Other - Middle Name:AFFAN
Other - Last Name:ABDELFATTAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1200 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24201-3924
Mailing Address - Country:US
Mailing Address - Phone:276-645-0977
Mailing Address - Fax:276-645-0309
Practice Address - Street 1:1200 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:VA
Practice Address - Zip Code:24201-3924
Practice Address - Country:US
Practice Address - Phone:276-645-0977
Practice Address - Fax:276-645-0309
Is Sole Proprietor?:No
Enumeration Date:2010-08-29
Last Update Date:2010-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202007263183500000X
TN00000063201835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist