Provider Demographics
NPI:1285157040
Name:ELSEIFY, BASSEM ADEL
Entity type:Individual
Prefix:
First Name:BASSEM
Middle Name:ADEL
Last Name:ELSEIFY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15912 E.STATE RD. 40
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34488
Mailing Address - Country:US
Mailing Address - Phone:352-625-2866
Mailing Address - Fax:352-625-2330
Practice Address - Street 1:15912 E.STATE RD. 40
Practice Address - Street 2:
Practice Address - City:SILVER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34488
Practice Address - Country:US
Practice Address - Phone:352-625-2866
Practice Address - Fax:352-625-2330
Is Sole Proprietor?:No
Enumeration Date:2017-07-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS54489183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1518988815OtherWINN-DIXIE
123OtherWINN-DIXIE