Provider Demographics
NPI:1093328023
Name:GUIRGUIS, SOHAD
Entity Type:Individual
Prefix:
First Name:SOHAD
Middle Name:
Last Name:GUIRGUIS
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 1:1010 WORLEY DR
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-5257
Mailing Address - Country:US
Mailing Address - Phone:417-255-8880
Mailing Address - Fax:
Practice Address - Street 1:1010 WORLEY DR
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-5257
Practice Address - Country:US
Practice Address - Phone:417-255-8880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013024747183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist