Provider Demographics
NPI:1033887393
Name:FAHMY, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:FAHMY
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 1:7200 RIDGE RD STE 106
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-6971
Mailing Address - Country:US
Mailing Address - Phone:727-312-4888
Mailing Address - Fax:727-312-4889
Practice Address - Street 1:7200 RIDGE RD STE 106
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-6971
Practice Address - Country:US
Practice Address - Phone:727-312-4888
Practice Address - Fax:727-312-4889
Is Sole Proprietor?:No
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS45984183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL45984OtherPHARMACIST LICENSE