Provider Demographics
NPI:1417245408
Name:SHENOUDA, JOHN SAMIR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:SAMIR
Last Name:SHENOUDA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 MIDDLETON ST
Mailing Address - Street 2:APT. 204
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37210-2080
Mailing Address - Country:US
Mailing Address - Phone:615-668-0793
Mailing Address - Fax:
Practice Address - Street 1:233 S LOWRY ST
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-3007
Practice Address - Country:US
Practice Address - Phone:615-355-4828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35902183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist