Provider Demographics
NPI:1003048729
Name:REMTULLAH, ARIF (PHARMD)
Entity Type:Individual
Prefix:
First Name:ARIF
Middle Name:
Last Name:REMTULLAH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31100 CORTEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FLORIDA
Mailing Address - Zip Code:34601
Mailing Address - Country:UM
Mailing Address - Phone:352-754-5154
Mailing Address - Fax:352-754-5215
Practice Address - Street 1:31100 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34602-7548
Practice Address - Country:US
Practice Address - Phone:352-754-5154
Practice Address - Fax:352-754-5215
Is Sole Proprietor?:No
Enumeration Date:2009-08-13
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41398183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist