Provider Demographics
NPI:1003462896
Name:KHEIR, DINA FARIS
Entity Type:Individual
Prefix:
First Name:DINA
Middle Name:FARIS
Last Name:KHEIR
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 1:9301 SUMMIT CENTRE WAY UNIT 1214
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-6056
Mailing Address - Country:US
Mailing Address - Phone:407-921-6656
Mailing Address - Fax:
Practice Address - Street 1:9301 SUMMIT CENTRE WAY UNIT 1214
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-6056
Practice Address - Country:US
Practice Address - Phone:407-921-6656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-16
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS59622183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist