Provider Demographics
NPI:1043656531
Name:DERBANI, HICHAM (PHARM D)
Entity Type:Individual
Prefix:
First Name:HICHAM
Middle Name:
Last Name:DERBANI
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16803 SW 79TH PL
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-4750
Mailing Address - Country:US
Mailing Address - Phone:786-537-1132
Mailing Address - Fax:
Practice Address - Street 1:200 SE 1ST ST FL 12
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33131-1912
Practice Address - Country:US
Practice Address - Phone:305-374-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-11
Last Update Date:2013-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41743183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist