Healthcare Provider Details

I. General information

NPI: 1205833456
Provider Name (Legal Business Name): NUSHOP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2005
Last Update Date: 11/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6046 HIGHWAY 53
HARVEST AL
35749-9538
US

IV. Provider business mailing address

6046 HIGHWAY 53
HARVEST AL
35749-9538
US

V. Phone/Fax

Practice location:
  • Phone: 256-858-9677
  • Fax: 256-858-2149
Mailing address:
  • Phone: 256-858-2288
  • Fax: 256-858-2149

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateAL

VIII. Authorized Official

Name: MR. MAZEN R NUWAYHID
Title or Position: PHARMACIST-OWNER
Credential: PHARM.D.
Phone: 256-858-2288