=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093808552
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MR. ABDEL R ARYAN
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2006
-----------------------------------------------------
Last Update Date | 05/28/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 57 HOMESTEAD RD NO.
-----------------------------------------------------
City | LEHIGH ACRES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33936
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-369-0141
-----------------------------------------------------
Fax | 239-368-0843
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 57 HOMESTEAD RD NO.
-----------------------------------------------------
City | LEHIGH ACRES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33936
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 239-369-0141
-----------------------------------------------------
Fax | 239-368-0843
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PS0024737
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------