Healthcare Provider Details

I. General information

NPI: 1821381005
Provider Name (Legal Business Name): SHERIF REZKALLA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2011
Last Update Date: 05/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 CARROLL PLZ
WESTMINSTER MD
21157-4601
US

IV. Provider business mailing address

22 CARROLL PLZ
WESTMINSTER MD
21157-4601
US

V. Phone/Fax

Practice location:
  • Phone: 410-876-1513
  • Fax: 410-857-5072
Mailing address:
  • Phone: 410-876-1513
  • Fax: 410-857-5072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number18613
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: