=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699094755
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHAMEEMA CHALLA
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/27/2010
-----------------------------------------------------
Last Update Date | 04/11/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5226 MAGNOLIA PL
-----------------------------------------------------
City | SEBRING
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33872-7927
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-414-8034
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5226 MAGNOLIA PL
-----------------------------------------------------
City | SEBRING
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33872-7927
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 863-414-8034
-----------------------------------------------------
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 | PS37458
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------