Provider Demographics
NPI:1720359110
Name:FACKIH, MAJED NADER (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MAJED
Middle Name:NADER
Last Name:FACKIH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7747 W HILLSBOROUGH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-4715
Mailing Address - Country:US
Mailing Address - Phone:813-890-0405
Mailing Address - Fax:727-865-5243
Practice Address - Street 1:7747 W HILLSBOROUGH AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-4715
Practice Address - Country:US
Practice Address - Phone:813-890-0405
Practice Address - Fax:727-865-5243
Is Sole Proprietor?:No
Enumeration Date:2012-01-18
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS38740183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS38740OtherSTATE LICENSE