=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164788733
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FADY S GIRGIS PHARMACIST
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/07/2012
-----------------------------------------------------
Last Update Date | 04/07/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7413 MIAMI LAKES DR
-----------------------------------------------------
City | MIAMI LAKES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33014-6818
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-335-1523
-----------------------------------------------------
Fax | 305-827-8248
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14624 BALGOWAN RD
-----------------------------------------------------
City | MIAMI LAKES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33016-6439
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-335-1523
-----------------------------------------------------
Fax | 305-827-8248
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PS35359
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------