Provider Demographics
NPI:1710009600
Name:RIZKALLAH, NAHLA D (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:NAHLA
Middle Name:D
Last Name:RIZKALLAH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1934 DATURA ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-3817
Mailing Address - Country:US
Mailing Address - Phone:941-366-8141
Mailing Address - Fax:
Practice Address - Street 1:2295 VICTORIA AVE
Practice Address - Street 2:SUITE 309
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-3884
Practice Address - Country:US
Practice Address - Phone:239-338-2926
Practice Address - Fax:239-338-2927
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS24799183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist