Healthcare Provider Details

I. General information

NPI: 1386084093
Provider Name (Legal Business Name): ADEL ELTANTAWY PHARM.D, BCOP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2013
Last Update Date: 09/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3850 HOLLYWOOD BLVD
HOLLYWOOD FL
33021-6748
US

IV. Provider business mailing address

3850 HOLLYWOOD BLVD
HOLLYWOOD FL
33021-6748
US

V. Phone/Fax

Practice location:
  • Phone: 954-251-8873
  • Fax:
Mailing address:
  • Phone: 954-251-8873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number27928
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number27928
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: