Provider Demographics
NPI:1346754777
Name:MALOOKA PHARMA CORP
Entity Type:Organization
Organization Name:MALOOKA PHARMA CORP
Other - Org Name:APOTHICARE AT LAKEWOOD RANCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:ABOUZEID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-479-8032
Mailing Address - Street 1:8618 EAST SR 70
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34202
Mailing Address - Country:US
Mailing Address - Phone:941-751-5000
Mailing Address - Fax:941-751-5002
Practice Address - Street 1:8618 E STATE ROAD 70
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34202-3785
Practice Address - Country:US
Practice Address - Phone:941-751-5000
Practice Address - Fax:941-751-5002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-21
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH311613336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2177548OtherPK