Healthcare Provider Details

I. General information

NPI: 1578631818
Provider Name (Legal Business Name): MOHAMED ABISOUROUR RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 26TH AVE EAST
BRADENTON FL
34208
US

IV. Provider business mailing address

2333 FEATHER SOUND DR A211
CLEARWATER FL
33762-3076
US

V. Phone/Fax

Practice location:
  • Phone: 941-708-7672
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS34402
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: