MEDICARE: MR. SHOAIB IMTIAZ SYED RPH

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	PR5234	ME

General Provider Information

NPI Number	:	1275849820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SHOAIB IMTIAZ SYED RPH

Provider Business Mailing Address
First Line	:	36 CHINA RD
Second Line	:
City	:	WINSLOW
State	:	ME
Zip	:	04901-7246
Country	:	US
Telephone Number	:	207-872-2727
Fax Number	:	207-873-4793

Provider Business Practice Location Address
First Line	:	36 CHINA RD
Second Line	:
City	:	WINSLOW
State	:	ME
Zip	:	04901-7246
Country	:	US
Telephone Number	:	207-872-2727
Fax Number	:	207-873-4793

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

Provider Enumeration Date	:	08/20/2010
Last Update Date	:	08/20/2010

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