Provider Demographics
NPI:1114042264
Name:SHEHAITA, SAMER A (RPH)
Entity Type:Individual
Prefix:MR
First Name:SAMER
Middle Name:A
Last Name:SHEHAITA
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:PO BOX 422231
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34742-2231
Mailing Address - Country:US
Mailing Address - Phone:407-973-4789
Mailing Address - Fax:
Practice Address - Street 1:705 1ST ST S
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-3602
Practice Address - Country:US
Practice Address - Phone:863-294-7487
Practice Address - Fax:863-299-0242
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS28842183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist