Healthcare Provider Details

I. General information

NPI: 1841128584
Provider Name (Legal Business Name): MOHAMMED MASFIKUL AZAM PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

380 CELEBRATION PL
CELEBRATION FL
34747-4606
US

IV. Provider business mailing address

5785 TIMBER MEADOW WAY
SAINT CLOUD FL
34771-7657
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-3856
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License NumberPS55657
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: