MEDICARE: MR. IHAB ELSEWISY 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	5302036744	MI

General Provider Information

NPI Number	:	1316225162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. IHAB ELSEWISY RPH

Provider Business Mailing Address
First Line	:	2971 PHEASANT RUN DR
Second Line	:	#J
City	:	JACKSON
State	:	MI
Zip	:	49202-1347
Country	:	US
Telephone Number	:	201-850-7640
Fax Number	:

Provider Business Practice Location Address
First Line	:	1733 SPRING ARBOR RD
Second Line	:	RITE AID #4539
City	:	JACKSON
State	:	MI
Zip	:	49203-2701
Country	:	US
Telephone Number	:	517-789-6630
Fax Number	:	517-789-8439

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

Provider Enumeration Date	:	07/28/2011
Last Update Date	:	07/28/2011

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