Provider Demographics
NPI:1053924928
Name:SHAWAHIN, MAHDEE
Entity type:Individual
Prefix:
First Name:MAHDEE
Middle Name:
Last Name:SHAWAHIN
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 1:1210 SUGAR CREEK SQ
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-4401
Mailing Address - Country:US
Mailing Address - Phone:636-326-5113
Mailing Address - Fax:
Practice Address - Street 1:1210 SUGAR CREEK SQ
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-4401
Practice Address - Country:US
Practice Address - Phone:636-326-5113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018041618183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist