Provider Demographics
NPI:1457799900
Name:HASSAN, A M MAHBUB
Entity Type:Individual
Prefix:
First Name:A M
Middle Name:MAHBUB
Last Name:HASSAN
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 1:2840 DAVID WALKER DR
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-6172
Mailing Address - Country:US
Mailing Address - Phone:352-357-6948
Mailing Address - Fax:
Practice Address - Street 1:2840 DAVID WALKER DR
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-6172
Practice Address - Country:US
Practice Address - Phone:352-357-6948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-06
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS38367183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist