Healthcare Provider Details

I. General information

NPI: 1861853616
Provider Name (Legal Business Name): ZABEENA P SHAIK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2016
Last Update Date: 03/08/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

728 E PULASKI HWY
ELKTON MD
21921-6029
US

IV. Provider business mailing address

728 E PULASKI HWY
ELKTON MD
21921-6029
US

V. Phone/Fax

Practice location:
  • Phone: 410-398-9595
  • Fax:
Mailing address:
  • Phone: 410-398-9595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number21857
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberA1-0004461
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: