Provider Demographics
NPI:1073885331
Name:SHAKER, ALBERT ISHAK
Entity Type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:ISHAK
Last Name:SHAKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 S GULFVIEW BLVD
Mailing Address - Street 2:APP.1106
Mailing Address - City:CLEARWATERBEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33767
Mailing Address - Country:US
Mailing Address - Phone:813-810-9070
Mailing Address - Fax:
Practice Address - Street 1:605 S PINELLAS AVE
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-3707
Practice Address - Country:US
Practice Address - Phone:727-942-1686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS43235183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist