Healthcare Provider Details

I. General information

NPI: 1336745181
Provider Name (Legal Business Name): SAMIH AYSHEH PHARM D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2020
Last Update Date: 12/08/2020
Certification Date: 12/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5905 US HIGHWAY 301 S
RIVERVIEW FL
33578-3800
US

IV. Provider business mailing address

18410 MEADOW BLOSSOM LN
TAMPA FL
33647-3255
US

V. Phone/Fax

Practice location:
  • Phone: 954-778-7333
  • Fax:
Mailing address:
  • Phone: 954-778-7333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS56754
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: