Healthcare Provider Details

I. General information

NPI: 1033055561
Provider Name (Legal Business Name): AHMED ELZENY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2026
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7099 W HIGHWAY 98
PANAMA CITY BEACH FL
32407-5415
US

IV. Provider business mailing address

2319 S HIGHWAY 77 UNIT 66
LYNN HAVEN FL
32444-7702
US

V. Phone/Fax

Practice location:
  • Phone: 917-794-6909
  • Fax:
Mailing address:
  • Phone: 917-794-6909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH36415
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: