Provider Demographics
NPI:1679863377
Name:WASSEF, MINA M (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:MINA
Middle Name:M
Last Name:WASSEF
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 1:577 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:PA
Mailing Address - Zip Code:17361-1737
Mailing Address - Country:US
Mailing Address - Phone:717-235-6854
Mailing Address - Fax:717-235-8039
Practice Address - Street 1:577 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:PA
Practice Address - Zip Code:17361-1737
Practice Address - Country:US
Practice Address - Phone:717-235-6854
Practice Address - Fax:717-235-8039
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-14
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP444981183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist