Healthcare Provider Details

I. General information

NPI: 1942740139
Provider Name (Legal Business Name): TALLAHASSEE CANCER INSTITUTE PL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2017
Last Update Date: 04/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1653 MAHAN CENTER BLVD SUITE A
TALLAHASSEE FL
32308-5454
US

IV. Provider business mailing address

1653 MAHAN CENTER BLVD SUITE A
TALLAHASSEE FL
32308-5454
US

V. Phone/Fax

Practice location:
  • Phone: 850-727-5502
  • Fax: 850-219-8003
Mailing address:
  • Phone: 850-727-5502
  • Fax: 850-219-8003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH30628
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: AMER RASSAM
Title or Position: MD
Credential:
Phone: 850-219-8000