Healthcare Provider Details

I. General information

NPI: 1346843745
Provider Name (Legal Business Name): MD AMINUL HOQUE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/18/2020
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12255 S CLEVELAND AVE
FORT MYERS FL
33907-3801
US

IV. Provider business mailing address

12255 S CLEVELAND AVE
FORT MYERS FL
33907-3801
US

V. Phone/Fax

Practice location:
  • Phone: 239-931-5924
  • Fax:
Mailing address:
  • Phone: 239-931-5924
  • Fax: 239-931-5947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS37228
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: