Provider Demographics
NPI:1407456908
Name:EL-SHERIF, TAREG
Entity Type:Individual
Prefix:
First Name:TAREG
Middle Name:
Last Name:EL-SHERIF
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 1:8923 W MILITARY DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-2102
Mailing Address - Country:US
Mailing Address - Phone:210-675-8480
Mailing Address - Fax:210-675-8480
Practice Address - Street 1:8923 W MILITARY DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78245-2102
Practice Address - Country:US
Practice Address - Phone:210-675-8480
Practice Address - Fax:210-675-8480
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX52603183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist