Provider Demographics
NPI:1861861742
Name:ELMOUSTAPHA, AICHETOU CHEIKH (PHARMD)
Entity Type:Individual
Prefix:
First Name:AICHETOU
Middle Name:CHEIKH
Last Name:ELMOUSTAPHA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6615 MAHAN DR
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-1400
Mailing Address - Country:US
Mailing Address - Phone:850-878-5559
Mailing Address - Fax:850-878-4909
Practice Address - Street 1:6615 MAHAN DR
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-1400
Practice Address - Country:US
Practice Address - Phone:850-878-5559
Practice Address - Fax:850-878-4909
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-21
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS46729183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS46729OtherSTATE LICENSE