=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558755280
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TAMIMI PHARMACY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/19/2015
-----------------------------------------------------
Last Update Date | 03/28/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12643 N 56TH ST
-----------------------------------------------------
City | TEMPLE TERRACE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33617-1221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-515-7918
-----------------------------------------------------
Fax | 813-515-7925
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12643 N 56TH ST
-----------------------------------------------------
City | TEMPLE TERRACE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33617-1221
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-515-7918
-----------------------------------------------------
Fax | 813-515-7925
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, AO
-----------------------------------------------------
Name | ABDELMOTI SALHAB
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 813-515-7918
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 333600000X
-----------------------------------------------------
Taxonomy Name | Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PH27365
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------