Healthcare Provider Details

I. General information

NPI: 1275365355
Provider Name (Legal Business Name): ALI FAKIH PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2024
Last Update Date: 08/16/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 S TAMIAMI TRL
SARASOTA FL
34239-3555
US

IV. Provider business mailing address

2042 OAK TER
SARASOTA FL
34231-3420
US

V. Phone/Fax

Practice location:
  • Phone: 941-917-9000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number67401
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: