Provider Demographics
NPI:1316247422
Name:RIZK, MOHAMED TAHA (RPH)
Entity type:Individual
Prefix:MR
First Name:MOHAMED
Middle Name:TAHA
Last Name:RIZK
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 LUMINARY CIR APT 102
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-6680
Mailing Address - Country:US
Mailing Address - Phone:718-790-6277
Mailing Address - Fax:
Practice Address - Street 1:1035 LUMINARY CIR APT 102
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-6680
Practice Address - Country:US
Practice Address - Phone:718-790-6277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS40859183500000X
NY20053203183500000X
NJ3123500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist