MEDICARE: MAHMOUD S. SHAKER B. SC PH D

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	116530	MN

General Provider Information

NPI Number	:	1205105129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAHMOUD S. SHAKER B. SC PH D

Provider Business Mailing Address
First Line	:	1995 SKILLMAN AVE W
Second Line	:
City	:	ROSEVILLE
State	:	MN
Zip	:	55113-5445
Country	:	US
Telephone Number	:	651-631-0673
Fax Number	:

Provider Business Practice Location Address
First Line	:	2387 HIGHWAY 10
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55112-4967
Country	:	US
Telephone Number	:	651-631-0673
Fax Number	:

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

Provider Enumeration Date	:	12/21/2011
Last Update Date	:	12/21/2011

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