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General NPI Number Information
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NPI Number | 1194096487
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Entity Type | Individual
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Provider Name | JAMAL M TAHA
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Gender | Male
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Dates
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Enumeration Date | 01/19/2012
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Last Update Date | 01/19/2012
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Provider Practice Location Address
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Address Line | 5211 S. CONWAY ROAD
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City | ORLANDO
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State | FL
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Zip | 32812
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Country | US
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Telephone | 407-812-8770
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Fax |
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Provider Business Mailing Address
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Address Line | 6063 LAKE MELROSE DRIVE
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City | ORLANDO
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State | FL
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Zip | 32829
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Country | US
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Telephone | 407-590-9265
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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 | PS23328
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License Number State | FL
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