Healthcare Provider Details

I. General information

NPI: 1043145220
Provider Name (Legal Business Name): MENA FAYEZ BASSALY SEWIHA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12753 UNIVERSITY AVE
CLIVE IA
50325-8246
US

IV. Provider business mailing address

4418 NW 166TH ST
CLIVE IA
50325-2564
US

V. Phone/Fax

Practice location:
  • Phone: 515-226-1786
  • Fax:
Mailing address:
  • Phone: 515-226-1786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number25508
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: