=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215371075
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HSP INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/24/2013
-----------------------------------------------------
Last Update Date | 04/24/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3415 W GLENDALE AVE STE 27A
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85051-8391
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-888-8128
-----------------------------------------------------
Fax | 480-888-8128
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3415 W GLENDALE AVE STE 27A
-----------------------------------------------------
City | PHOENIX
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85051-8391
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-888-8128
-----------------------------------------------------
Fax | 480-888-8128
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PIC
-----------------------------------------------------
Name | MOHAMED ESLAM ELMISSIREY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 480-444-6612
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | Y005651
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------