Provider Demographics
NPI:1518205962
Name:MANKARIOUS, WAGIH F (RPH)
Entity Type:Individual
Prefix:
First Name:WAGIH
Middle Name:F
Last Name:MANKARIOUS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17315 BOY SCOUT RD
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-2105
Mailing Address - Country:US
Mailing Address - Phone:813-961-4849
Mailing Address - Fax:
Practice Address - Street 1:3939 VAN DYKE RD
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33558-8001
Practice Address - Country:US
Practice Address - Phone:813-264-5993
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS25900183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist