Provider Demographics
NPI:1790204972
Name:YACHOUH, AFRAM
Entity Type:Individual
Prefix:
First Name:AFRAM
Middle Name:
Last Name:YACHOUH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1981 HIDDEN SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-2347
Mailing Address - Country:US
Mailing Address - Phone:727-460-7672
Mailing Address - Fax:
Practice Address - Street 1:500 E LAKE RD
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685-2428
Practice Address - Country:US
Practice Address - Phone:727-784-1413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-19
Last Update Date:2017-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS56945183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist