Provider Demographics
NPI:1851660328
Name:MESSIHA, MINA S (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MINA
Middle Name:S
Last Name:MESSIHA
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 1:1202 N MAGNOLIA DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-4634
Mailing Address - Country:US
Mailing Address - Phone:850-877-1407
Mailing Address - Fax:
Practice Address - Street 1:1202 N MAGNOLIA DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-4634
Practice Address - Country:US
Practice Address - Phone:850-877-1407
Practice Address - Fax:
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
FLPS0040490183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS0040490OtherSTATE MEDICAL LICENSE
153234OtherNABP