Provider Demographics
NPI:1558655605
Name:GAD, AMIRA (RPH)
Entity Type:Individual
Prefix:
First Name:AMIRA
Middle Name:
Last Name:GAD
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 1:4012 SAWYER RD STE 107
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-1231
Mailing Address - Country:US
Mailing Address - Phone:941-500-5955
Mailing Address - Fax:941-866-7677
Practice Address - Street 1:4012 SAWYER RD STE 107
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-1231
Practice Address - Country:US
Practice Address - Phone:941-500-5955
Practice Address - Fax:941-866-7677
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2018-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS46587183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist