=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740525708
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHADY S ABDELMASIH RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/03/2012
-----------------------------------------------------
Last Update Date | 09/07/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 31201 US HIGHWAY 19 N SUITE 1
-----------------------------------------------------
City | PALM HARBOR
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34684
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-666-0248
-----------------------------------------------------
Fax | 727-772-6969
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 31201 US HIGHWAY 19 N SUITE 1
-----------------------------------------------------
City | PALM HARBOR
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34684
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-666-0248
-----------------------------------------------------
Fax | 727-772-6969
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PS46532
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------