Provider Demographics
NPI:1295335768
Name:MOURGAN, SHENOUDA
Entity type:Individual
Prefix:
First Name:SHENOUDA
Middle Name:
Last Name:MOURGAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12815 KINKAID MEADOWS LN
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-3794
Mailing Address - Country:US
Mailing Address - Phone:832-295-8500
Mailing Address - Fax:
Practice Address - Street 1:12815 KINKAID MEADOWS LN
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-3794
Practice Address - Country:US
Practice Address - Phone:832-295-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2025-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20075183500000X
TX52622183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist