Provider Demographics
NPI:1205833456
Name:NUSHOP LLC
Entity Type:Organization
Organization Name:NUSHOP LLC
Other - Org Name:SUR-SAV PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MAZEN
Authorized Official - Middle Name:R
Authorized Official - Last Name:NUWAYHID
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:256-858-2288
Mailing Address - Street 1:6046 HIGHWAY 53
Mailing Address - Street 2:
Mailing Address - City:HARVEST
Mailing Address - State:AL
Mailing Address - Zip Code:35749-9538
Mailing Address - Country:US
Mailing Address - Phone:256-858-2288
Mailing Address - Fax:256-858-2149
Practice Address - Street 1:6046 HIGHWAY 53
Practice Address - Street 2:
Practice Address - City:HARVEST
Practice Address - State:AL
Practice Address - Zip Code:35749-9538
Practice Address - Country:US
Practice Address - Phone:256-858-9677
Practice Address - Fax:256-858-2149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL100003084Medicaid