Provider Demographics
NPI:1114106622
Name:SHAHRAKI, SAMMY KOSCO (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:SAMMY
Middle Name:KOSCO
Last Name:SHAHRAKI
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:757 FLAMINGO DR
Mailing Address - Street 2:
Mailing Address - City:APOLLO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33572-2448
Mailing Address - Country:US
Mailing Address - Phone:813-505-3929
Mailing Address - Fax:813-383-5993
Practice Address - Street 1:757 FLAMINGO DR
Practice Address - Street 2:
Practice Address - City:APOLLO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33572-2448
Practice Address - Country:US
Practice Address - Phone:813-505-3929
Practice Address - Fax:813-383-5993
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS29606183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist