Provider Demographics
NPI:1053681270
Name:ASL, GHOLAMALI (RPH)
Entity Type:Individual
Prefix:
First Name:GHOLAMALI
Middle Name:
Last Name:ASL
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 1:4380 RIDGEMOOR DR N
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-3171
Mailing Address - Country:US
Mailing Address - Phone:727-772-7525
Mailing Address - Fax:
Practice Address - Street 1:33670 US 19 N
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-2640
Practice Address - Country:US
Practice Address - Phone:727-785-7643
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS32440183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist