Provider Demographics
NPI:1598361198
Name:SHALABI, ANGELA SHALABI (RPH)
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:SHALABI
Last Name:SHALABI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17299 PHLOX DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33967-2589
Mailing Address - Country:US
Mailing Address - Phone:239-288-1176
Mailing Address - Fax:
Practice Address - Street 1:11300 LINDBERGH BLVD STE 107
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33913-8827
Practice Address - Country:US
Practice Address - Phone:866-249-2696
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-08
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS61643183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS61643OtherREGISTERED PHARMACIST LICENSE