=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336745181
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SAMIH AYSHEH PHARM D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2020
-----------------------------------------------------
Last Update Date | 12/08/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5905 US HIGHWAY 301 S
-----------------------------------------------------
City | RIVERVIEW
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33578-3800
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-778-7333
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18410 MEADOW BLOSSOM LN
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33647-3255
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-778-7333
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PS56754
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------