Provider Demographics
NPI:1801409107
Name:ANIS, BISHOY
Entity Type:Individual
Prefix:
First Name:BISHOY
Middle Name:
Last Name:ANIS
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 1:4057 CROCKERS LAKE BLVD APT 2511
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-5319
Mailing Address - Country:US
Mailing Address - Phone:941-877-8753
Mailing Address - Fax:
Practice Address - Street 1:4057 CROCKERS LAKE BLVD APT 2511
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34238-5319
Practice Address - Country:US
Practice Address - Phone:941-877-8753
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS60348183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty