Provider Demographics
NPI:1659419133
Name:KAMAL, AKM MUSTAFA
Entity Type:Individual
Prefix:MR
First Name:AKM
Middle Name:MUSTAFA
Last Name:KAMAL
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 1:11513 CENTAUR WAY
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33971-3767
Mailing Address - Country:US
Mailing Address - Phone:239-939-7191
Mailing Address - Fax:239-772-4000
Practice Address - Street 1:1003 SANTA BARBARA BLVD
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33991-2852
Practice Address - Country:US
Practice Address - Phone:239-772-4000
Practice Address - Fax:239-772-9135
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS37308183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist