Provider Demographics
NPI:1386459790
Name:IJAZ, REHMA
Entity type:Individual
Prefix:
First Name:REHMA
Middle Name:
Last Name:IJAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15012 HUNTCLIFF PARK WAY
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32824-5680
Mailing Address - Country:US
Mailing Address - Phone:321-424-9354
Mailing Address - Fax:
Practice Address - Street 1:7003 PRESIDENTS DR STE 250
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32809-5533
Practice Address - Country:US
Practice Address - Phone:689-837-1464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS67938183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist