=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205833456
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NUSHOP LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/01/2005
-----------------------------------------------------
Last Update Date | 11/15/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6046 HIGHWAY 53
-----------------------------------------------------
City | HARVEST
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35749-9538
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-858-9677
-----------------------------------------------------
Fax | 256-858-2149
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6046 HIGHWAY 53
-----------------------------------------------------
City | HARVEST
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35749-9538
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-858-2288
-----------------------------------------------------
Fax | 256-858-2149
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST-OWNER
-----------------------------------------------------
Name | MR. MAZEN R NUWAYHID
-----------------------------------------------------
Credential | PHARM.D.
-----------------------------------------------------
Telephone | 256-858-2288
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------