Provider Demographics
NPI:1982207403
Name:MORCOS, SHEHAB
Entity Type:Individual
Prefix:
First Name:SHEHAB
Middle Name:
Last Name:MORCOS
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 1:11973 CRESTRIDGE LOOP
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-0021
Mailing Address - Country:US
Mailing Address - Phone:914-473-3684
Mailing Address - Fax:
Practice Address - Street 1:12015 LITTLE RD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-2922
Practice Address - Country:US
Practice Address - Phone:727-862-3575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS53147183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist