Provider Demographics
NPI:1730651894
Name:ELSHAARAWY, MOEMEN M (RPH)
Entity Type:Individual
Prefix:
First Name:MOEMEN
Middle Name:M
Last Name:ELSHAARAWY
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 1:7800 W APPLETON AVE UNIT C
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53218-5309
Mailing Address - Country:US
Mailing Address - Phone:917-698-7629
Mailing Address - Fax:
Practice Address - Street 1:6300 W BROWN DEER RD
Practice Address - Street 2:
Practice Address - City:BROWN DEER
Practice Address - State:WI
Practice Address - Zip Code:53223-2233
Practice Address - Country:US
Practice Address - Phone:917-698-7629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-28
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI19223-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI19223-40OtherWISCONSIN DSPS