Healthcare Provider Details

I. General information

NPI: 1578563888
Provider Name (Legal Business Name): MAKSOUD PHARM INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13769 QUEENS BLVD
BRIARWOOD NY
11435-1845
US

IV. Provider business mailing address

13769 QUEENS BLVD
BRIARWOOD NY
11435-1845
US

V. Phone/Fax

Practice location:
  • Phone: 718-297-4424
  • Fax: 718-526-6104
Mailing address:
  • Phone: 718-297-4424
  • Fax: 718-526-6104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number039326
License Number StateNY

VIII. Authorized Official

Name: MR. HOSSAM ELSAYED ABDEL-MAKSOUD
Title or Position: OWNER
Credential: PHARMACIST
Phone: 718-297-4424