Provider Demographics
NPI:1336314012
Name:ABDEL-MAKSOUD, MOHAMED (RPH)
Entity Type:Individual
Prefix:MR
First Name:MOHAMED
Middle Name:
Last Name:ABDEL-MAKSOUD
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 1:1749 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-5202
Mailing Address - Country:US
Mailing Address - Phone:646-672-1760
Mailing Address - Fax:
Practice Address - Street 1:1749 1ST AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-5202
Practice Address - Country:US
Practice Address - Phone:646-672-1760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050735183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist