Provider Demographics
NPI:1457400921
Name:BRAHMBHATT, SAMIR (RPH)
Entity Type:Individual
Prefix:MR
First Name:SAMIR
Middle Name:
Last Name:BRAHMBHATT
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 1:310 W MITCHELL HAMMOCK RD STE 500
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-4921
Mailing Address - Country:US
Mailing Address - Phone:407-366-2677
Mailing Address - Fax:
Practice Address - Street 1:310 W MITCHELL HAMMOCK RD STE 500
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-4921
Practice Address - Country:US
Practice Address - Phone:407-366-2677
Practice Address - Fax:407-366-2535
Is Sole Proprietor?:No
Enumeration Date:2007-01-10
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS340981835P0018X
FL34098183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPU6089OtherCONSULTANT PHARMACIST
FL5503695OtherHEALTH CARE RISK MANAGER
FLPS34098OtherPHARMACIST