Provider Demographics
NPI:1821693474
Name:ALSABBAGH, MAHMOUD AHAMD ZAKI (RPH)
Entity Type:Individual
Prefix:
First Name:MAHMOUD
Middle Name:AHAMD ZAKI
Last Name:ALSABBAGH
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 1:441 LONG HILL RD
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-4149
Mailing Address - Country:US
Mailing Address - Phone:860-405-1919
Mailing Address - Fax:
Practice Address - Street 1:441 LONG HILL RD
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-4149
Practice Address - Country:US
Practice Address - Phone:860-405-1919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT15151183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist