Provider Demographics
NPI:1578861944
Name:SHALTAF, MAHMOUD JAMIL (RPH)
Entity Type:Individual
Prefix:MR
First Name:MAHMOUD
Middle Name:JAMIL
Last Name:SHALTAF
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4198 SEEMA DR
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45440-3742
Mailing Address - Country:US
Mailing Address - Phone:937-427-4016
Mailing Address - Fax:
Practice Address - Street 1:846 E MAIN ST
Practice Address - Street 2:
Practice Address - City:TROTWOOD
Practice Address - State:OH
Practice Address - Zip Code:45426-2911
Practice Address - Country:US
Practice Address - Phone:937-529-4433
Practice Address - Fax:937-715-4447
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03326985183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist