Provider Demographics
NPI:1568941441
Name:MAHFOUZ, DEBRA COPELAND (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:COPELAND
Last Name:MAHFOUZ
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:
Other - Last Name:COPELAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD, RPH
Mailing Address - Street 1:1135 MORTON ST
Mailing Address - Street 2:
Mailing Address - City:MATTAPAN
Mailing Address - State:MA
Mailing Address - Zip Code:02126-2834
Mailing Address - Country:US
Mailing Address - Phone:617-533-2300
Mailing Address - Fax:617-282-1582
Practice Address - Street 1:735 ATTUCKS LN
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-1867
Practice Address - Country:US
Practice Address - Phone:508-778-0300
Practice Address - Fax:508-778-5478
Is Sole Proprietor?:No
Enumeration Date:2018-08-10
Last Update Date:2018-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21098183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist