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General NPI Number Information
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NPI Number | 1518130590
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Entity Type | Organization
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Legal Business Name | MOHAMED SALEH DISPENSARY
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Dates
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Enumeration Date | 04/10/2008
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Last Update Date | 04/10/2008
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Provider Practice Location Address
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Address Line | 1408 SAN MARCO BLVD
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City | JACKSONVILLE
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State | FL
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Zip | 32207-8536
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Country | US
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Telephone | 904-398-0009
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Fax | 904-346-0887
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Provider Business Mailing Address
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Address Line | 2301 W SAMPLE RD SUITE 7A
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City | POMPANO BEACH
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State | FL
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Zip | 33073-3081
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Country | US
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Telephone | 954-935-6063
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Fax | 954-935-0470
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Authorized Official
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Title or Position | EXECUTIVE ADMINISTRATOR
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Name | MS. CICELY EASON
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Credential |
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Telephone | 954-935-6063
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number | ME43827
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License Number State | FL
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