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General NPI Number Information
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NPI Number | 1104110576
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Entity Type | Individual
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Provider Name | JOHN MANSOUR PHARMD
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Gender | Male
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Dates
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Enumeration Date | 06/02/2011
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Last Update Date | 07/07/2021
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Provider Practice Location Address
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Address Line | 1314 S BAY ST
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City | EUSTIS
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State | FL
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Zip | 32726-5551
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Country | US
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Telephone | 352-357-6699
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Fax | 352-357-2390
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Provider Business Mailing Address
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Address Line | PO BOX 301143
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City | FERN PARK
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State | FL
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Zip | 32730-1143
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Country | US
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Telephone | 407-490-8682
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS45551
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License Number State | FL
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