Provider Demographics
NPI:1073116521
Name:KHANDKER, FARAH ZEBA
Entity Type:Individual
Prefix:
First Name:FARAH
Middle Name:ZEBA
Last Name:KHANDKER
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 1:4710 PALM BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33905-3637
Mailing Address - Country:US
Mailing Address - Phone:239-822-9972
Mailing Address - Fax:
Practice Address - Street 1:4710 PALM BEACH BLVD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-3637
Practice Address - Country:US
Practice Address - Phone:239-822-9972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS34693183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist