Provider Demographics
NPI:1356623649
Name:SALEEB, BEMAN MIKHAEL
Entity type:Individual
Prefix:MR
First Name:BEMAN
Middle Name:MIKHAEL
Last Name:SALEEB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:BEMAN
Other - Middle Name:MIKHAEL
Other - Last Name:SALEEB
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:2402 RIDGEMOOR DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7512
Mailing Address - Country:US
Mailing Address - Phone:407-575-0711
Mailing Address - Fax:
Practice Address - Street 1:12279 LKAEUNDER HIL ROAD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-7512
Practice Address - Country:US
Practice Address - Phone:407-575-0711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-13
Last Update Date:2012-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS40879183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist