Provider Demographics
NPI:1053989236
Name:ELGARAWANY, MOHAB
Entity type:Individual
Prefix:
First Name:MOHAB
Middle Name:
Last Name:ELGARAWANY
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 1:1123 N VAN BUREN ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-3219
Mailing Address - Country:US
Mailing Address - Phone:414-374-9219
Mailing Address - Fax:414-273-8810
Practice Address - Street 1:1123 N VAN BUREN ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-3219
Practice Address - Country:US
Practice Address - Phone:414-347-9219
Practice Address - Fax:414-273-8810
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20560-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist