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General NPI Number Information
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NPI Number | 1205105129
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Entity Type | Individual
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Provider Name | MAHMOUD S. SHAKER B. SC PH D
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Gender | Male
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Dates
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Enumeration Date | 12/21/2011
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Last Update Date | 12/21/2011
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Provider Practice Location Address
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Address Line | 2387 HIGHWAY 10
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City | SAINT PAUL
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State | MN
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Zip | 55112-4967
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Country | US
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Telephone | 651-631-0673
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Fax |
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Provider Business Mailing Address
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Address Line | 1995 SKILLMAN AVE W
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City | ROSEVILLE
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State | MN
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Zip | 55113-5445
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Country | US
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Telephone | 651-631-0673
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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 | 116530
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License Number State | MN
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