Provider Demographics
NPI:1518130590
Name:MOHAMED SALEH DISPENSARY
Entity Type:Organization
Organization Name:MOHAMED SALEH DISPENSARY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CICELY
Authorized Official - Middle Name:
Authorized Official - Last Name:EASON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-935-6063
Mailing Address - Street 1:2301 W SAMPLE RD
Mailing Address - Street 2:SUITE 7A
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33073-3081
Mailing Address - Country:US
Mailing Address - Phone:954-935-6063
Mailing Address - Fax:954-935-0470
Practice Address - Street 1:1408 SAN MARCO BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8536
Practice Address - Country:US
Practice Address - Phone:904-398-0009
Practice Address - Fax:904-346-0887
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PHYSICIAN'S CHOICE DISPENSING SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME43827332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site