Healthcare Provider Details

I. General information

NPI: 1811730104
Provider Name (Legal Business Name): MR. BASSEM GAMAL GHALY METRY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2024
Last Update Date: 06/14/2024
Certification Date: 06/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 NORTHLAKE BLVD
NORTH PALM BEACH FL
33408-5421
US

IV. Provider business mailing address

312 NORTHLAKE BLVD
NORTH PALM BEACH FL
33408-5421
US

V. Phone/Fax

Practice location:
  • Phone: 561-845-2186
  • Fax:
Mailing address:
  • Phone: 561-845-2186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS66955
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: