Healthcare Provider Details

I. General information

NPI: 1730426693
Provider Name (Legal Business Name): EMAD Y YACOUB RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2013
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2660 W STATE ROAD 434
LONGWOOD FL
32779-4400
US

IV. Provider business mailing address

2660 W STATE ROAD 434
LONGWOOD FL
32779-4400
US

V. Phone/Fax

Practice location:
  • Phone: 407-960-4246
  • Fax:
Mailing address:
  • Phone: 407-960-4246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRPH023091
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS38338
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: