Provider Demographics
NPI:1336818756
Name:GHANEM, MAHMOUD (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MAHMOUD
Middle Name:
Last Name:GHANEM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4610 KEW DR
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-2465
Mailing Address - Country:US
Mailing Address - Phone:440-212-8383
Mailing Address - Fax:
Practice Address - Street 1:29000 LORAIN RD
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-4016
Practice Address - Country:US
Practice Address - Phone:440-777-4524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-09
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03441157183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist