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General NPI Number Information
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NPI Number | 1124400288
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Entity Type | Individual
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Provider Name | MOSTAFA S ELGIBALY
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Gender | Male
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Dates
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Enumeration Date | 06/25/2015
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Last Update Date | 06/25/2015
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Provider Practice Location Address
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Address Line | 216 ROUTE 36 WALGREENS STORE 5201
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City | WEST LONG BRANCH
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State | NJ
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Zip | 07764-1305
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Country | US
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Telephone | 732-728-2283
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Fax |
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Provider Business Mailing Address
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Address Line | 217 GARFIELD AVE
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City | AVON BY THE SEA
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State | NJ
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Zip | 07717-1207
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Country | US
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Telephone | 848-223-2155
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 28RI03706700
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License Number State | NJ
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