Provider Demographics
NPI:1437751716
Name:ABU-SHANAB, NASER M (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:NASER
Middle Name:M
Last Name:ABU-SHANAB
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:MR
Other - First Name:NASER
Other - Middle Name:M
Other - Last Name:ABU-SHANAB
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:650 S TRUMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-2235
Mailing Address - Country:US
Mailing Address - Phone:636-675-3609
Mailing Address - Fax:636-464-1783
Practice Address - Street 1:650 S TRUMAN BLVD
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-2235
Practice Address - Country:US
Practice Address - Phone:636-937-3527
Practice Address - Fax:636-464-1783
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009023422183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist