Provider Demographics
NPI:1023732062
Name:ISLAM, MOHAMMAD AMINUL (RPH)
Entity type:Individual
Prefix:
First Name:MOHAMMAD
Middle Name:AMINUL
Last Name:ISLAM
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2124 WOLF RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT DORA
Mailing Address - State:FL
Mailing Address - Zip Code:32757-9145
Mailing Address - Country:US
Mailing Address - Phone:352-551-5900
Mailing Address - Fax:
Practice Address - Street 1:1995 N HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-6728
Practice Address - Country:US
Practice Address - Phone:352-589-1330
Practice Address - Fax:352-589-7469
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS38953183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist