Provider Demographics
NPI:1679196729
Name:ATTALLAH, SALEM GEORGES (RPH)
Entity Type:Individual
Prefix:MR
First Name:SALEM
Middle Name:GEORGES
Last Name:ATTALLAH
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 1:3420 VOLLEY CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32277-2770
Mailing Address - Country:US
Mailing Address - Phone:904-881-8220
Mailing Address - Fax:
Practice Address - Street 1:8560 ARGYLE FOREST BLVD UNIT 1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-5997
Practice Address - Country:US
Practice Address - Phone:904-779-7700
Practice Address - Fax:904-777-3054
Is Sole Proprietor?:No
Enumeration Date:2020-05-24
Last Update Date:2020-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS47530183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist