Provider Demographics
NPI:1902195431
Name:ELWAN, HESHAM F
Entity Type:Individual
Prefix:
First Name:HESHAM
Middle Name:F
Last Name:ELWAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1517 MEMORY LN
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-2668
Mailing Address - Country:US
Mailing Address - Phone:252-266-2842
Mailing Address - Fax:
Practice Address - Street 1:1123 N RALEIGH ST
Practice Address - Street 2:
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27801-5885
Practice Address - Country:US
Practice Address - Phone:252-266-2842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-05
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC20872183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist