Provider Demographics
NPI:1164788733
Name:GIRGIS, FADY S (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:FADY
Middle Name:S
Last Name:GIRGIS
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14624 BALGOWAN RD
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33016-6439
Mailing Address - Country:US
Mailing Address - Phone:305-335-1523
Mailing Address - Fax:305-827-8248
Practice Address - Street 1:7413 MIAMI LAKES DR
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-6818
Practice Address - Country:US
Practice Address - Phone:305-335-1523
Practice Address - Fax:305-827-8248
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-07
Last Update Date:2012-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS35359183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist