Provider Demographics
NPI:1184913360
Name:SOUS, MINA (RPH)
Entity type:Individual
Prefix:
First Name:MINA
Middle Name:
Last Name:SOUS
Suffix:
Gender:
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14733 BRADDOCK OAK DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-4957
Mailing Address - Country:US
Mailing Address - Phone:179-325-4449
Mailing Address - Fax:
Practice Address - Street 1:9310 SOUTHPARK CENTER LOOP
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8634
Practice Address - Country:US
Practice Address - Phone:917-932-5444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI03410800183500000X
NYI057944-1183500000X
TX52989183500000X
FLPS54172183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist