Provider Demographics
NPI:1205604188
Name:HASSAN, BOSHRA EBRAHIM (RPH)
Entity type:Individual
Prefix:
First Name:BOSHRA
Middle Name:EBRAHIM
Last Name:HASSAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4666 FOREST RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-1974
Mailing Address - Country:US
Mailing Address - Phone:865-242-0298
Mailing Address - Fax:
Practice Address - Street 1:11310 CORNELL PARK DR
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-1814
Practice Address - Country:US
Practice Address - Phone:513-782-3366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03443811183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist