Provider Demographics
NPI:1699058487
Name:FARAG, HALIM (RPH)
Entity type:Individual
Prefix:
First Name:HALIM
Middle Name:
Last Name:FARAG
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 1:1903 STATE ROAD 60 E
Mailing Address - Street 2:
Mailing Address - City:LAKE WALES
Mailing Address - State:FL
Mailing Address - Zip Code:33853-4329
Mailing Address - Country:US
Mailing Address - Phone:863-676-9496
Mailing Address - Fax:863-678-1829
Practice Address - Street 1:1903 STATE ROAD 60 E
Practice Address - Street 2:
Practice Address - City:LAKE WALES
Practice Address - State:FL
Practice Address - Zip Code:33853-4329
Practice Address - Country:US
Practice Address - Phone:863-676-9496
Practice Address - Fax:863-678-1829
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-28
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS39793183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist