Provider Demographics
NPI:1346503281
Name:ELSHAFIE, FAIZA SIDDIEG
Entity Type:Individual
Prefix:
First Name:FAIZA
Middle Name:SIDDIEG
Last Name:ELSHAFIE
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 1:5610 LILLBURN PL
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-6894
Mailing Address - Country:US
Mailing Address - Phone:410-750-2019
Mailing Address - Fax:
Practice Address - Street 1:1340 EASTERN BLVD
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:MD
Practice Address - Zip Code:21221-3423
Practice Address - Country:US
Practice Address - Phone:410-780-7020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD19475183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist