Healthcare Provider Details

I. General information

NPI: 1508703612
Provider Name (Legal Business Name): NOHA HAFEZ PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 CRESCENT LAKE WAY
ORMOND BEACH FL
32174-6798
US

IV. Provider business mailing address

4 CRESCENT LAKE WAY
ORMOND BEACH FL
32174-6798
US

V. Phone/Fax

Practice location:
  • Phone: 386-795-7031
  • Fax:
Mailing address:
  • Phone: 386-795-7031
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS43322
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: