MEDICARE: ALLIE MANSOUR

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS47026	FL

General Provider Information

NPI Number	:	1245994326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLIE MANSOUR

Provider Business Mailing Address
First Line	:	7925 66TH WAY N
Second Line	:
City	:	PINELLAS PARK
State	:	FL
Zip	:	33781-2059
Country	:	US
Telephone Number	:	313-289-2911
Fax Number	:

Provider Business Practice Location Address
First Line	:	7333 PARK BLVD N
Second Line	:
City	:	PINELLAS PARK
State	:	FL
Zip	:	33781-2922
Country	:	US
Telephone Number	:	727-546-5866
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2021
Last Update Date	:	10/26/2021

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Directions to “ ALLIE MANSOUR ” Practice Location

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