Healthcare Provider Details

I. General information

NPI: 1790204972
Provider Name (Legal Business Name): AFRAM YACHOUH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2017
Last Update Date: 09/19/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E LAKE RD
PALM HARBOR FL
34685-2428
US

IV. Provider business mailing address

1981 HIDDEN SPRINGS DR
TRINITY FL
34655-2347
US

V. Phone/Fax

Practice location:
  • Phone: 727-784-1413
  • Fax:
Mailing address:
  • Phone: 727-460-7672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS56945
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: