SHENOUDA A KERIACOUS (NPI# 1528404738) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528404738 |
| Entity Type | Individual |
| Full Name | SHENOUDA A KERIACOUS |
| Credential | RPH |
| Practice Address |
4502 E Oak St Phoenix AZ 85008-2411 |
| Mailing Address |
10000 Mickelberry Rd Nw Silverdale WA 98383-8302 |
| Practice Telephone | 6028080111 |
| Mailing Telephone | 4803635525 |
| Mailing Fax Number | 3603082125 |
| Enumeration Date | 2013-05-14 |
| Last Update Date | 2020-01-27 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 183500000X | Pharmacist | S017054 | AZ | Pharmacy Service Providers |
| Y | 1835P0018X |
Pharmacist Specialization: Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
PH60631590 | WA | Pharmacy Service Providers |
| Street Address |
4502 E OAK ST |
| City | PHOENIX |
| State | AZ |
| Zip Code | 85008-2411 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114037710 | Costco Wholesale Corporation | Pharmacy | 4502 E Oak St, Phoenix, AZ 85008 | 2006-08-30 |
| 1740824119 | Brooke D Kruman | Optometrist | 4502 E Oak St, Phoenix, AZ 85008-2411 | 2019-10-29 |
| 1245715895 | Anne M Feeney | Clinical Pharmacology | 4502 E Oak St, Phoenix, AZ 85008-2411 | 2018-09-29 |
| 1164934386 | Diana Ann Kung | Pharmacist | 4502 E Oak St, Phoenix, AZ 85008-2411 | 2017-10-27 |
| 1669901534 | Elizabeth Hundelt | Optometrist | 4502 E Oak St, Phoenix, AZ 85008-2411 | 2017-06-05 |
| 1063804771 | Costco Wholesale Corporation | Hearing Aid Equipment | 4502 E Oak St, Phoenix, AZ 85008-2411 | 2015-03-04 |
| 1881084937 | Costco Wholesale Corporation | Eyewear Supplier (Equipment, not the service) | 4502 E Oak St, Phoenix, AZ 85008-2411 | 2015-01-28 |
| 1790096337 | Siva Kumar Kamineni | Pharmacist | 4502 E Oak St, Phoenix, AZ 85008-2411 | 2010-06-29 |
| 1346563293 | Joseph Anthony Pinto | Pharmacist | 4502 E Oak St, Phoenix, AZ 85008-2411 | 2010-03-07 |
| 1437480795 | Tim A Logan | Pharmacist | 4502 E Oak St, Phoenix, AZ 85008-2411 | 2010-01-26 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821607060 | Am Apnea and Tmj LLC | Durable Medical Equipment & Medical Supplies | 2303 N. 44thst., Suite 14-1008, Phoenix, AZ 85008 | 2020-07-23 |
| 1194341131 | Abdulbaril Olandapo Olagunju | Student in an Organized Health Care Education/Training Program | 2601 E Roosevelt Street, Valleywise Health, Phoenix, AZ 85008 | 2020-06-24 |
| 1376164632 | Abdul Rahman Raed Mustafa Halawa | Student in an Organized Health Care Education/Training Program | 2601 E Roosevelt St Valleywise Health, Phoenix, AZ 85008 | 2020-04-28 |
| 1245869460 | Zachary Masuda | Student in an Organized Health Care Education/Training Program | Valleywise Health Medical Center, 2601 E Roosevelt St, Phoenix, AZ 85008 | 2020-04-08 |
| 1942840145 | Cana Behavior LLC | Physical Therapist | 2412 N 36 Pl, Phoenix, AZ 85008 | 2020-01-15 |
| 1871158188 | Fred Gardezy | Student in an Organized Health Care Education/Training Program | Maricopa Integrated Health System 2601 E. Roosevelt St., Phoenix, AZ 85008 | 2019-05-02 |
| 1225692346 | Navkaran Singh Girgla | Student in an Organized Health Care Education/Training Program | 2601 East Roosevelt St., Phoenix, AZ 85008 | 2019-04-24 |
| 1316412323 | Southwest Human Developement | Early Intervention Provider Agency | 2850 N 24h Street, Phoenix, AZ 85008 | 2018-10-05 |
| 1558885970 | Mona Ridhwan Ziems | Midwife | 1919 N 31st St, Phoenix, AZ 85008 | 2017-07-27 |
| 1093244451 | Shana Cynamon | Audiologist | 1801 N 37th Pl, Phoenix, AZ 85008 | 2017-06-08 |
| Find all providers in zip 85008 | ||||
| Taxonomy Code | 1835P0018X |
| Grouping | Pharmacy Service Providers |
| Classification | Pharmacist |
| Specialization | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist |
| Pharmacist Clinician/Clinical Pharmacy Specialist is a pharmacist with additional training and an expanded scope of practice that may include prescriptive authority, therapeutic management, and disease management. |
| Notes: Source: National Uniform Claim Committee, 2007 [1/1/2008: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1487101028 | Marisol Ibarra | Pharmacist | 4802 N 12th St Apt 1086, Phoenix, AZ 85014-4098 | 2016-09-01 |
| 1457719858 | John Randle House | Pharmacist | 3345 E Behrend Dr, Phoenix, AZ 85050-3983 | 2016-02-01 |
| 1790113637 | Patricia Dorothea Hoyt | Pharmacist | 1300 N 12th St # 406, Phoenix, AZ 85006-2848 | 2013-10-30 |
| 1326313982 | Pamela Ann Wolfson | Pharmacist | 4212 E Sunrise Dr, Phoenix, AZ 85044-1012 | 2012-03-15 |
| 1114928314 | Daniel Patrick Boyle | Pharmacist | 650 E Indian School Rd Dept Of, Phoenix, AZ 85012-1839 | 2005-08-10 |
| 1619584620 | Anh Nguyen Truc Huynh | Pharmacist | 3511 W Peoria Ave, Phoenix, AZ 85029-4037 | 2020-09-24 |
| 1376154385 | Doyinsola Adetunji | Pharmacist | 4707 E Shea Blvd, Phoenix, AZ 85028-4215 | 2020-08-13 |
| 1881220432 | Palna Suri Patel | Pharmacist | 650 E Indian School Rd, Phoenix, AZ 85012-1839 | 2020-03-16 |
| 1780163287 | Delia Saadeh Ziadat | Pharmacist | 1111 E Mcdowell Rd, Phoenix, AZ 85006-2612 | 2018-08-07 |
| 1144723495 | Maricopa County D.b.a. Maricopa County Depart | Pharmacist | 1645 E Roosevelt St, Phoenix, AZ 85006-3638 | 2018-03-13 |
| Find all providers in PHOENIX | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.