Provider Demographics
NPI:1154925733
Name:GARNER, AZAM (PHARMD)
Entity type:Individual
Prefix:
First Name:AZAM
Middle Name:
Last Name:GARNER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:AZAM
Other - Middle Name:
Other - Last Name:HAMEED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1368 PONCE DR
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-5315
Mailing Address - Country:US
Mailing Address - Phone:623-326-4469
Mailing Address - Fax:
Practice Address - Street 1:3200 ROLLING OAKS BLVD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34747-3052
Practice Address - Country:US
Practice Address - Phone:321-677-3972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS57348183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist