Provider Demographics
NPI:1578558342
Name:GIRGIS, AMGAD H (RPH)
Entity Type:Individual
Prefix:MR
First Name:AMGAD
Middle Name:H
Last Name:GIRGIS
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 1:3300 SW 15TH ST
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-8126
Mailing Address - Country:US
Mailing Address - Phone:954-354-0530
Mailing Address - Fax:954-354-0538
Practice Address - Street 1:3300 SW 15TH ST
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-8126
Practice Address - Country:US
Practice Address - Phone:954-354-0530
Practice Address - Fax:954-354-0538
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH16660183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1086594OtherNCPDP
FLPH16660OtherFLORIDA BOARD OF PHARMACY
FLPH16660OtherFLORIDA BOARD OF PHARMACY