Provider Demographics
NPI:1073894325
Name:MIKHAIL, MAGUED R (RPH)
Entity Type:Individual
Prefix:
First Name:MAGUED
Middle Name:R
Last Name:MIKHAIL
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 1:12279 LAKE UNDERHILL RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-5010
Mailing Address - Country:US
Mailing Address - Phone:407-273-0817
Mailing Address - Fax:407-273-1267
Practice Address - Street 1:12279 LAKE UNDERHILL RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-5010
Practice Address - Country:US
Practice Address - Phone:407-273-0817
Practice Address - Fax:407-273-1267
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS42904183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist