| Provider / Organization | NPI | Date Certified |
|---|---|---|
| SHADI BASHAR | 1811590193 | 2020-11-22 |
| Entity Type | Individual |
| Provider Name | Shadi Bashar RPH |
| Practice Office Address | 8805 CENTRE PARK DR COLUMBIA, MD US |
| Practice Office Telephone | 4433645181 |
| Mailing Address | 8805 CENTRE PARK DR COLUMBIA, MD 210452117 US |
| Business Telephone | 4433645181 |
| Business Fax | 4433645190 |
| Code | License No | State |
|---|---|---|
| 183500000X PRIMARY | 22871 | MD |