Provider Demographics
NPI:1801518238
Name:SHENOUDA, NAGEH MAHROUS (PHARMACIST)
Entity type:Individual
Prefix:
First Name:NAGEH
Middle Name:MAHROUS
Last Name: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 1:635 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01020-3047
Mailing Address - Country:US
Mailing Address - Phone:508-667-2489
Mailing Address - Fax:
Practice Address - Street 1:635 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01020-3047
Practice Address - Country:US
Practice Address - Phone:508-667-2489
Practice Address - Fax:413-200-3095
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-13
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH238688183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist