Provider Demographics
NPI:1770808727
Name:ESTAFANOUS, EFFAT AZIZ (RPH)
Entity type:Individual
Prefix:MR
First Name:EFFAT
Middle Name:AZIZ
Last Name:ESTAFANOUS
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 1:627 AVENUE E
Mailing Address - Street 2:APT # 2
Mailing Address - City:BAYONNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07002-4835
Mailing Address - Country:US
Mailing Address - Phone:551-221-5671
Mailing Address - Fax:
Practice Address - Street 1:1290 W BAY DR
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-2204
Practice Address - Country:US
Practice Address - Phone:551-221-5671
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-01
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS46016183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist