Provider Demographics
NPI:1558811745
Name:MANSSOUR, REMON A
Entity Type:Individual
Prefix:
First Name:REMON
Middle Name:A
Last Name:MANSSOUR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:REMON
Other - Middle Name:A
Other - Last Name:MANSSOUR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:540 S HUNT CLUB BLVD
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-4960
Mailing Address - Country:US
Mailing Address - Phone:407-862-5823
Mailing Address - Fax:407-862-5366
Practice Address - Street 1:540 S HUNT CLUB BLVD
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-4960
Practice Address - Country:US
Practice Address - Phone:407-862-5823
Practice Address - Fax:407-862-5366
Is Sole Proprietor?:No
Enumeration Date:2016-10-11
Last Update Date:2017-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS56357183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist