Provider Demographics
NPI:1538793906
Name:SABABA, SHAFWAT TANVIR (PHARMD)
Entity type:Individual
Prefix:DR
First Name:SHAFWAT
Middle Name:TANVIR
Last Name:SABABA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:SHAFWAT
Other - Middle Name:
Other - Last Name:TANVIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4761 N CONGRESS AVE
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-7940
Mailing Address - Country:US
Mailing Address - Phone:561-619-4461
Mailing Address - Fax:561-619-4668
Practice Address - Street 1:4761 N CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-7940
Practice Address - Country:US
Practice Address - Phone:561-619-4461
Practice Address - Fax:561-619-4668
Is Sole Proprietor?:No
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS59837183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist