Provider Demographics
NPI:1619514379
Name:FORGHAB, MICHAEL Y
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:Y
Last Name:FORGHAB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5352 N HABANA AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-6838
Mailing Address - Country:US
Mailing Address - Phone:718-683-7575
Mailing Address - Fax:813-644-6850
Practice Address - Street 1:5352 N HABANA AVE STE 1
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-6838
Practice Address - Country:US
Practice Address - Phone:718-683-7575
Practice Address - Fax:813-644-6850
Is Sole Proprietor?:No
Enumeration Date:2019-12-02
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41871183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS41871OtherPHARMACIST LICENSE