MEDICARE: MISBAH MUSSARAT MAHMOOD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS36585	FL

General Provider Information

NPI Number	:	1275181356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISBAH MUSSARAT MAHMOOD

Provider Business Mailing Address
First Line	:	1723 CAROLINA WREN DR
Second Line	:
City	:	OCOEE
State	:	FL
Zip	:	34761-9176
Country	:	US
Telephone Number	:	407-227-8111
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 S ORANGE BLOSSOM TRL
Second Line	:
City	:	APOPKA
State	:	FL
Zip	:	32703-7603
Country	:	US
Telephone Number	:	407-553-4108
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2019
Last Update Date	:	08/31/2019

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