Healthcare Provider Details

I. General information

NPI: 1821600784
Provider Name (Legal Business Name): HANY ABDELMASIH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2020
Last Update Date: 08/20/2020
Certification Date: 08/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 2ND ST
HENDERSON KY
42420-3357
US

IV. Provider business mailing address

1355 2ND ST
HENDERSON KY
42420-3357
US

V. Phone/Fax

Practice location:
  • Phone: 270-827-9857
  • Fax:
Mailing address:
  • Phone: 270-827-9857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH100002565
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number019770
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: