Provider Demographics
NPI:1700528049
Name:ISKANDOR-SHENOUDA, NABIL SARUAT (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:NABIL
Middle Name:SARUAT
Last Name:ISKANDOR-SHENOUDA
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8758 CASHIO ST APT 1
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-3484
Mailing Address - Country:US
Mailing Address - Phone:310-903-9958
Mailing Address - Fax:
Practice Address - Street 1:8758 CASHIO ST APT 1
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-3484
Practice Address - Country:US
Practice Address - Phone:310-903-9958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-08
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59436183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist