Provider Demographics
NPI:1578563888
Name:MAKSOUD PHARM INC.
Entity Type:Organization
Organization Name:MAKSOUD PHARM INC.
Other - Org Name:MANSON PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HOSSAM
Authorized Official - Middle Name:ELSAYED
Authorized Official - Last Name:ABDEL-MAKSOUD
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:718-297-4424
Mailing Address - Street 1:13769 QUEENS BLVD
Mailing Address - Street 2:
Mailing Address - City:BRIARWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11435-1845
Mailing Address - Country:US
Mailing Address - Phone:718-297-4424
Mailing Address - Fax:718-526-6104
Practice Address - Street 1:13769 QUEENS BLVD
Practice Address - Street 2:
Practice Address - City:BRIARWOOD
Practice Address - State:NY
Practice Address - Zip Code:11435-1845
Practice Address - Country:US
Practice Address - Phone:718-297-4424
Practice Address - Fax:718-526-6104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039326183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3388279OtherNABP
NY01382750Medicaid
NY3388279OtherNABP