Provider Demographics
NPI:1639458706
Name:SHENODA, JOHN FAYEZ (PHARMD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:FAYEZ
Last Name:SHENODA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15544 OLD HICKORY BLVD
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-7329
Mailing Address - Country:US
Mailing Address - Phone:615-331-4961
Mailing Address - Fax:
Practice Address - Street 1:15544 OLD HICKORY BLVD
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-7329
Practice Address - Country:US
Practice Address - Phone:615-331-4961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-08
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN39480183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist