Provider Demographics
NPI:1083379580
Name:SHEIKH-ALI, SALAM
Entity Type:Individual
Prefix:
First Name:SALAM
Middle Name:
Last Name:SHEIKH-ALI
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 1:12311 KENSINGTON LAKES DR UNIT 1604
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-7197
Mailing Address - Country:US
Mailing Address - Phone:904-510-9270
Mailing Address - Fax:
Practice Address - Street 1:12311 KENSINGTON LAKES DR UNIT 1604
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32246-7197
Practice Address - Country:US
Practice Address - Phone:904-510-9270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-01
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS63349183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist