Provider Demographics
NPI:1477158715
Name:ABRAHAM, BIJU A
Entity Type:Individual
Prefix:DR
First Name:BIJU
Middle Name:A
Last Name:ABRAHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1916 RUTHERFORD DR
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:FL
Mailing Address - Zip Code:33527-4925
Mailing Address - Country:US
Mailing Address - Phone:352-359-7002
Mailing Address - Fax:
Practice Address - Street 1:704 WEST MARTIN LUTHER KING DRIVE
Practice Address - Street 2:
Practice Address - City:SEFFNER
Practice Address - State:FL
Practice Address - Zip Code:33584-3358
Practice Address - Country:US
Practice Address - Phone:813-681-4431
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-03
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS42117183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist