Provider Demographics
NPI:1093318305
Name:FAWAZ, DARWISH ALI (RPH)
Entity Type:Individual
Prefix:
First Name:DARWISH
Middle Name:ALI
Last Name:FAWAZ
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 1:7071 MITCHELL BLVD
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-4726
Mailing Address - Country:US
Mailing Address - Phone:727-376-8181
Mailing Address - Fax:
Practice Address - Street 1:7071 MITCHELL BLVD
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-4726
Practice Address - Country:US
Practice Address - Phone:727-376-8181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS24539183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist