Provider Demographics
NPI:1417120205
Name:SHALABY, MAGED
Entity Type:Individual
Prefix:MR
First Name:MAGED
Middle Name:
Last Name:SHALABY
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 1:340 W 23RD ST STE D2
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4541
Mailing Address - Country:US
Mailing Address - Phone:850-615-1000
Mailing Address - Fax:850-215-3344
Practice Address - Street 1:340 W 23RD ST STE D2
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4541
Practice Address - Country:US
Practice Address - Phone:850-615-1000
Practice Address - Fax:850-215-3344
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-11
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047484183500000X
GARPH023796183500000X
FLPS43085183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist