=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124237680
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BEHROOZ SOJERI B.S
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2007
-----------------------------------------------------
Last Update Date | 02/18/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 754 S GOLDENROD RD
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32822-8108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-243-2513
-----------------------------------------------------
Fax | 407-243-2223
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 754 S GOLDENROD RD
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32822-8108
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-243-2513
-----------------------------------------------------
Fax | 407-243-2223
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PS0028252
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------