Provider Demographics
NPI:1558033274
Name:MASOUD, GEORGINA NABIL (RPH)
Entity Type:Individual
Prefix:
First Name:GEORGINA
Middle Name:NABIL
Last Name:MASOUD
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:332 SHANE CT APT 1
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-2722
Mailing Address - Country:US
Mailing Address - Phone:608-609-7074
Mailing Address - Fax:
Practice Address - Street 1:34 SCHROEDER CT
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-2526
Practice Address - Country:US
Practice Address - Phone:608-733-6389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20964-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist