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General NPI Number Information
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NPI Number | 1902776594
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Entity Type | Organization
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Legal Business Name | SRQ VACCINATION CLINIC LLC
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Dates
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Enumeration Date | 11/07/2025
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Last Update Date | 12/18/2025
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Provider Practice Location Address
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Address Line | 4020 SAWYER RD
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City | SARASOTA
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State | FL
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Zip | 34233-1272
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Country | US
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Telephone | 941-366-7475
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Fax |
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Provider Business Mailing Address
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Address Line | 4020 SAWYER RD
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City | SARASOTA
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State | FL
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Zip | 34233-1272
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Country | US
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Telephone | 941-366-7475
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Fax |
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Authorized Official
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Title or Position | PHARMACIST-IN-CHARGE/OWNER
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Name | TAMER HANY GUIRGUIS
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Credential | PHARM.D
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Telephone | 941-424-5041
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number |
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License Number State |
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