Provider Demographics
NPI:1073116893
Name:FAWAZ, TAREK ALI JR (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:TAREK
Middle Name:ALI
Last Name:FAWAZ
Suffix:JR
Gender:M
Credentials:PHARM D
Other - Prefix:DR
Other - First Name:TAREK
Other - Middle Name:ALI
Other - Last Name:FAWAZ
Other - Suffix:SR
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:301 3RD ST S
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4228
Mailing Address - Country:US
Mailing Address - Phone:727-822-7115
Mailing Address - Fax:727-822-9997
Practice Address - Street 1:301 3RD ST S
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4228
Practice Address - Country:US
Practice Address - Phone:727-822-7115
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS50532183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist