Provider Demographics
NPI:1063805588
Name:SHADAB, FARZANA (RPH)
Entity type:Individual
Prefix:
First Name:FARZANA
Middle Name:
Last Name:SHADAB
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5828 TULIP FLOWER DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-3735
Mailing Address - Country:US
Mailing Address - Phone:813-523-8587
Mailing Address - Fax:
Practice Address - Street 1:10665 BIG BEND RD
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-7176
Practice Address - Country:US
Practice Address - Phone:813-234-3216
Practice Address - Fax:813-234-3264
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-09
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS42293183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist