Provider Demographics
NPI:1114649993
Name:FARHAT, NOUR K
Entity Type:Individual
Prefix:
First Name:NOUR
Middle Name:K
Last Name:FARHAT
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 1:19061 PORTO NUEVO DR
Mailing Address - Street 2:BUILDING 43 UNIT 205
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33967
Mailing Address - Country:US
Mailing Address - Phone:713-392-4084
Mailing Address - Fax:
Practice Address - Street 1:24800 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-7053
Practice Address - Country:US
Practice Address - Phone:239-947-6999
Practice Address - Fax:239-947-2954
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS63617183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF630-631-97-713-0OtherDRIVER'S LISENCE