Provider Demographics
NPI:1093283764
Name:ABDELMAKSOUD, MAHMOUD (RPH)
Entity Type:Individual
Prefix:
First Name:MAHMOUD
Middle Name:
Last Name:ABDELMAKSOUD
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 1:1815 SHOREMEADE RD STE 216
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-7314
Mailing Address - Country:US
Mailing Address - Phone:161-575-3687
Mailing Address - Fax:
Practice Address - Street 1:1401 BEN SAWYER BLVD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-4574
Practice Address - Country:US
Practice Address - Phone:843-881-1725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-11
Last Update Date:2018-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPHA-PHA-LIC-39589183500000X
KY019562183500000X
SC37634183500000X
DCPH100002786183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist