Provider Demographics
NPI:1750672283
Name:SHABANA, MOHAMED MARAWAN (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:MOHAMED
Middle Name:MARAWAN
Last Name:SHABANA
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:519 CRAWLEY RUN APT 208
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:45458-7330
Mailing Address - Country:US
Mailing Address - Phone:609-770-1058
Mailing Address - Fax:
Practice Address - Street 1:2532 E 3RD ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45403-2019
Practice Address - Country:US
Practice Address - Phone:937-258-8101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03127742-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist