Healthcare Provider Details

I. General information

NPI: 1730722364
Provider Name (Legal Business Name): JOHN HELMY HANNA NEAMATALLA PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2019
Last Update Date: 10/27/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4965 HIGHWAY 90
PACE FL
32571-1408
US

IV. Provider business mailing address

3883 ELEVATOR CT
PACE FL
32571-6418
US

V. Phone/Fax

Practice location:
  • Phone: 850-995-5115
  • Fax:
Mailing address:
  • Phone: 609-424-8434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16653
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number28RI03318200
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number19135080552
License Number StateMI
# 4
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS44224
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: