Provider Demographics
NPI:1376973495
Name:SHENOUDA, SAHAR (PHARMACY)
Entity Type:Individual
Prefix:
First Name:SAHAR
Middle Name:
Last Name:SHENOUDA
Suffix:
Gender:F
Credentials:PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6823 FORT HAMILTON PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-5856
Mailing Address - Country:US
Mailing Address - Phone:718-745-0733
Mailing Address - Fax:
Practice Address - Street 1:6823 FORT HAMILTON PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-5856
Practice Address - Country:US
Practice Address - Phone:718-745-0733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-26
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048962 DUP183500000X
MI5302036569183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist