=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538216486
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YUSUF BHAIJI PHARMD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/04/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 17221 NW 27TH AVE
-----------------------------------------------------
City | OPA LOCKA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33056-4418
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-625-1574
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2640 S UNIVERSITY DR APT #123
-----------------------------------------------------
City | DAVIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33328-1473
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-723-1573
-----------------------------------------------------
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 | PS39160
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------