MEDICARE: SHAHUL ABUSALIH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RP452920	PA

General Provider Information

NPI Number	:	1063986735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAHUL ABUSALIH

Provider Business Mailing Address
First Line	:	3312 CIRCLE BROOK DR APT D
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-8231
Country	:	US
Telephone Number	:	717-590-0940
Fax Number	:

Provider Business Practice Location Address
First Line	:	5201 SPRING RD STE 6
Second Line	:
City	:	SHERMANS DALE
State	:	PA
Zip	:	17090-8582
Country	:	US
Telephone Number	:	717-582-7781
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2019
Last Update Date	:	01/16/2019

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Directions to “ SHAHUL ABUSALIH ” Practice Location

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