Provider Demographics
NPI:1578150355
Name:ATALLA, EZZAT (RPH)
Entity Type:Individual
Prefix:
First Name:EZZAT
Middle Name:
Last Name:ATALLA
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 1:4211 LITTLE RD # 4
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-1606
Mailing Address - Country:US
Mailing Address - Phone:727-372-5222
Mailing Address - Fax:727-372-5225
Practice Address - Street 1:4211 LITTLE RD # 4
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34655-1606
Practice Address - Country:US
Practice Address - Phone:727-372-5222
Practice Address - Fax:727-372-5225
Is Sole Proprietor?:No
Enumeration Date:2020-12-28
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41010183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist