MEDICARE: SHADY MAHROUS JOHN TAWADROUS

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	PS51531	FL

General Provider Information

NPI Number	:	1275938821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHADY MAHROUS JOHN TAWADROUS

Provider Business Mailing Address
First Line	:	2928 BANCROFT CIR E
Second Line	:	APT F
City	:	PALM HARBOR
State	:	FL
Zip	:	34683-2536
Country	:	US
Telephone Number	:	727-437-9538
Fax Number	:

Provider Business Practice Location Address
First Line	:	2928 BANCROFT CIR E
Second Line	:	APT F
City	:	PALM HARBOR
State	:	FL
Zip	:	34683-2536
Country	:	US
Telephone Number	:	727-437-9538
Fax Number	:

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

Provider Enumeration Date	:	10/24/2014
Last Update Date	:	10/24/2014

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