Provider Demographics
NPI:1215039755
Name:BOUTRUS, SIHAM NASSIF (RPH)
Entity Type:Individual
Prefix:MRS
First Name:SIHAM
Middle Name:NASSIF
Last Name:BOUTRUS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13231 SW 17TH CT
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-3416
Mailing Address - Country:US
Mailing Address - Phone:954-438-4003
Mailing Address - Fax:
Practice Address - Street 1:4201 NW 88TH AVE
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-6047
Practice Address - Country:US
Practice Address - Phone:954-749-6965
Practice Address - Fax:954-749-6138
Is Sole Proprietor?:No
Enumeration Date:2006-09-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS38487183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0556050814Medicare ID - Type Unspecified