Healthcare Provider Details

I. General information

NPI: 1710565460
Provider Name (Legal Business Name): MOHAMED HASSANEIN-ELEMBABI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 04/22/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10503 W THUNDERBIRD BLVD STE 101B
SUN CITY AZ
85351-2719
US

IV. Provider business mailing address

10503 W THUNDERBIRD BLVD STE 101B
SUN CITY AZ
85351-2719
US

V. Phone/Fax

Practice location:
  • Phone: 602-800-3336
  • Fax:
Mailing address:
  • Phone: 480-479-1258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS016520
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: