MEDICARE: RANDA ALSAADI PS

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	1835P1200X	Pharmacotherapy Pharmacist	PS42076	FL

General Provider Information

NPI Number	:	1649698689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RANDA ALSAADI PS

Provider Business Mailing Address
First Line	:	1420 NEW BELLEVUE AVE APT 2103
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32114-5660
Country	:	US
Telephone Number	:	706-799-9036
Fax Number	:

Provider Business Practice Location Address
First Line	:	2566 S ATLANTIC AVE
Second Line	:
City	:	DAYTONA BEACH SHORES
State	:	FL
Zip	:	32118-5523
Country	:	US
Telephone Number	:	706-799-9036
Fax Number	:

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

Provider Enumeration Date	:	04/05/2014
Last Update Date	:	04/05/2014

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