Provider Demographics
NPI:1639353865
Name:GERGES NAKHLA, SANAA BADIE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:SANAA
Middle Name:BADIE
Last Name:GERGES NAKHLA
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 1:8230 CAZENOVIA RD
Mailing Address - Street 2:
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-8726
Mailing Address - Country:US
Mailing Address - Phone:315-682-9153
Mailing Address - Fax:315-680-1023
Practice Address - Street 1:8230 CAZENOVIA RD
Practice Address - Street 2:
Practice Address - City:MANLIUS
Practice Address - State:NY
Practice Address - Zip Code:13104-8726
Practice Address - Country:US
Practice Address - Phone:315-682-9153
Practice Address - Fax:315-680-1023
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-24
Last Update Date:2007-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045043183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00572692Medicaid