Provider Demographics
NPI:1073389714
Name:MIKHAEL, SOUZAN
Entity Type:Individual
Prefix:
First Name:SOUZAN
Middle Name:
Last Name:MIKHAEL
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 1:3517 FAIRWAY FOREST DR
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-1003
Mailing Address - Country:US
Mailing Address - Phone:727-900-2610
Mailing Address - Fax:
Practice Address - Street 1:105 MARINER BLVD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609-5625
Practice Address - Country:US
Practice Address - Phone:352-200-5835
Practice Address - Fax:352-200-5836
Is Sole Proprietor?:No
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS66020183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist