Healthcare Provider Details

I. General information

NPI: 1710731393
Provider Name (Legal Business Name): AMGAD MALAK MEKHAIL RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2024
Last Update Date: 04/11/2024
Certification Date: 04/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14836 CHERRY BLOSSOM WAY
PUNTA GORDA FL
33955-6317
US

IV. Provider business mailing address

14836 CHERRY BLOSSOM WAY
PUNTA GORDA FL
33955-6317
US

V. Phone/Fax

Practice location:
  • Phone: 973-870-1265
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS60345
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: