Provider Demographics
NPI:1679615868
Name:BISHARA, EDWARD F (RPH)
Entity Type:Individual
Prefix:MR
First Name:EDWARD
Middle Name:F
Last Name:BISHARA
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 1:18531 AMBLY LANE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647
Mailing Address - Country:US
Mailing Address - Phone:813-973-4324
Mailing Address - Fax:
Practice Address - Street 1:36348 STATE ROAD 54
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33541
Practice Address - Country:US
Practice Address - Phone:813-788-2421
Practice Address - Fax:813-788-3104
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0030926183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist