Provider Demographics
NPI:1316214620
Name:HAMDOUN, MAHMOUD HUSSEIN
Entity Type:Individual
Prefix:MR
First Name:MAHMOUD
Middle Name:HUSSEIN
Last Name:HAMDOUN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 W MANOA RD
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-4614
Mailing Address - Country:US
Mailing Address - Phone:267-506-5124
Mailing Address - Fax:
Practice Address - Street 1:2727 W CHELTENHAM AVE
Practice Address - Street 2:
Practice Address - City:WYNCOTE
Practice Address - State:PA
Practice Address - Zip Code:19095-2930
Practice Address - Country:US
Practice Address - Phone:215-886-7399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP445329183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist