Healthcare Provider Details

I. General information

NPI: 1144006388
Provider Name (Legal Business Name): SIBAUS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2023
Last Update Date: 09/05/2023
Certification Date: 09/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 CLEVELAND ST
ELYRIA OH
44035-4106
US

IV. Provider business mailing address

710 CLEVELAND ST
ELYRIA OH
44035-4106
US

V. Phone/Fax

Practice location:
  • Phone: 440-581-7730
  • Fax: 440-581-7732
Mailing address:
  • Phone: 440-581-7730
  • Fax: 440-581-7732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. SHERIF MANKARYOUS
Title or Position: DIRECTOR
Credential: RPH
Phone: 440-725-9938