Provider Demographics
NPI:1790054229
Name:REMTULLAH, AQUIL (RPH)
Entity Type:Individual
Prefix:MR
First Name:AQUIL
Middle Name:
Last Name:REMTULLAH
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 1:7815 S US HIGHWAY 17/92
Mailing Address - Street 2:
Mailing Address - City:FERN PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32730-2261
Mailing Address - Country:US
Mailing Address - Phone:407-331-0968
Mailing Address - Fax:407-331-7904
Practice Address - Street 1:7815 S US HIGHWAY 17/92
Practice Address - Street 2:
Practice Address - City:FERN PARK
Practice Address - State:FL
Practice Address - Zip Code:32730-2261
Practice Address - Country:US
Practice Address - Phone:407-331-0968
Practice Address - Fax:407-331-7904
Is Sole Proprietor?:No
Enumeration Date:2011-12-29
Last Update Date:2011-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS34539183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL361924025OtherTAX ID