Provider Demographics
NPI:1275849820
Name:SYED, SHOAIB IMTIAZ (RPH)
Entity Type:Individual
Prefix:MR
First Name:SHOAIB
Middle Name:IMTIAZ
Last Name:SYED
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 1:36 CHINA RD
Mailing Address - Street 2:
Mailing Address - City:WINSLOW
Mailing Address - State:ME
Mailing Address - Zip Code:04901-7246
Mailing Address - Country:US
Mailing Address - Phone:207-872-2727
Mailing Address - Fax:207-873-4793
Practice Address - Street 1:36 CHINA RD
Practice Address - Street 2:
Practice Address - City:WINSLOW
Practice Address - State:ME
Practice Address - Zip Code:04901-7246
Practice Address - Country:US
Practice Address - Phone:207-872-2727
Practice Address - Fax:207-873-4793
Is Sole Proprietor?:No
Enumeration Date:2010-08-20
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR5234183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist