Provider Demographics
NPI:1609901891
Name:BADR, ASHRAF R (RPH)
Entity Type:Individual
Prefix:MR
First Name:ASHRAF
Middle Name:R
Last Name:BADR
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 1:12717 CYNTHIA LANE
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34715
Mailing Address - Country:US
Mailing Address - Phone:321-438-0129
Mailing Address - Fax:352-753-3406
Practice Address - Street 1:944 BICHARA BLVD
Practice Address - Street 2:
Practice Address - City:LADY LAKE
Practice Address - State:FL
Practice Address - Zip Code:32159-7714
Practice Address - Country:US
Practice Address - Phone:352-753-6115
Practice Address - Fax:352-753-3406
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0028419183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0556050100Medicare ID - Type UnspecifiedWINN DIXIE PHARMACY