Provider Demographics
NPI:1962820407
Name:MEKLAT, FAROUK (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:FAROUK
Middle Name:
Last Name:MEKLAT
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 1:2400 TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-5928
Mailing Address - Country:US
Mailing Address - Phone:941-639-1144
Mailing Address - Fax:
Practice Address - Street 1:2400 TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-5928
Practice Address - Country:US
Practice Address - Phone:941-639-1144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-02
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS49391183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist