Healthcare Provider Details

I. General information

NPI: 1417445222
Provider Name (Legal Business Name): HAIDY GERGES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/26/2018
Last Update Date: 04/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 W ALLUVIAL AVE STE 101
FRESNO CA
93711-5509
US

IV. Provider business mailing address

2646 CLARINET DR
ORLANDO FL
32837-7060
US

V. Phone/Fax

Practice location:
  • Phone: 800-797-3543
  • Fax:
Mailing address:
  • Phone: 321-210-4342
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS56817
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: