Provider Demographics
NPI:1205663531
Name:MABROUK, SAMY A (RPH)
Entity type:Individual
Prefix:
First Name:SAMY
Middle Name:A
Last Name:MABROUK
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 1:8 CHESTNUT ST APT 2L
Mailing Address - Street 2:
Mailing Address - City:DUDLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01571-3266
Mailing Address - Country:US
Mailing Address - Phone:508-615-2525
Mailing Address - Fax:
Practice Address - Street 1:514 DENSLOW ST
Practice Address - Street 2:
Practice Address - City:WINDSOR LOCKS
Practice Address - State:CT
Practice Address - Zip Code:06096-1657
Practice Address - Country:US
Practice Address - Phone:860-698-5935
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTPCT.0015791183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist