Healthcare Provider Details

I. General information

NPI: 1043565534
Provider Name (Legal Business Name): AHMAD SHEHAB PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2012
Last Update Date: 07/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2761 MIGLIARA LN
OCOEE FL
34761-5030
US

IV. Provider business mailing address

2761 MIGLIARA LN
OCOEE FL
34761-5030
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-4517
  • Fax:
Mailing address:
  • Phone: 407-303-4517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPS49146
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: