Provider Demographics
NPI:1043587843
Name:FARAG-EL-MASSAH, SHEIREN (PHARMD, PHD)
Entity type:Individual
Prefix:DR
First Name:SHEIREN
Middle Name:
Last Name:FARAG-EL-MASSAH
Suffix:
Gender:F
Credentials:PHARMD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10105 INDIGO DR
Mailing Address - Street 2:
Mailing Address - City:EDEN PRAIRIE
Mailing Address - State:MN
Mailing Address - Zip Code:55347-1211
Mailing Address - Country:US
Mailing Address - Phone:952-446-5162
Mailing Address - Fax:
Practice Address - Street 1:6525 UNIVERSITY AVE NE
Practice Address - Street 2:WALGREENS PHARMACY
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432
Practice Address - Country:US
Practice Address - Phone:763-586-0730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119883183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist