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General NPI Number Information
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NPI Number | 1104335322
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Entity Type | Individual
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Provider Name | ANTOINE MOURANI
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Gender | Male
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Dates
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Enumeration Date | 09/20/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1303 SE 17TH ST SUITE D1
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City | FORT LAUDERDALE
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State | FL
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Zip | 33316
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Country | US
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Telephone | 954-687-0774
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Fax |
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Provider Business Mailing Address
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Address Line | 1303 SE 17TH ST STE D1
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City | FORT LAUDERDALE
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State | FL
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Zip | 33316-1722
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Country | US
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Telephone | 954-687-0774
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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 | PS54673
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License Number State | FL
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