Healthcare Provider Details

I. General information

NPI: 1124935267
Provider Name (Legal Business Name): BASMA AL KHATEEB
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 OAKFIELD DR
BRANDON FL
33511-5779
US

IV. Provider business mailing address

14405 SEATTLE SLEW LN
SUN CITY CENTER FL
33573-0260
US

V. Phone/Fax

Practice location:
  • Phone: 813-916-1839
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS59001
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: