Basic Information
| Provider Information | |||||||||
| NPI: | 1184134173 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ELNASHAR | ||||||||
| FirstName: | GHADA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 612 37TH AVE NE | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554213606 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 205 WABASHA ST S | ||||||||
| Address2: | |||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551071805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512938100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2017 | ||||||||
| LastUpdateDate: | 10/04/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 123586 | MN | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.