Provider Demographics
NPI:1770869398
Name:ANBA KARAS LLC
Entity type:Organization
Organization Name:ANBA KARAS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:ABDELMASEEH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:321-735-4991
Mailing Address - Street 1:3650 MURRELL RD STE 120
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4780
Mailing Address - Country:US
Mailing Address - Phone:321-735-4991
Mailing Address - Fax:321-735-4993
Practice Address - Street 1:3650 MURRELL RD STE 120
Practice Address - Street 2:
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-4780
Practice Address - Country:US
Practice Address - Phone:321-735-4991
Practice Address - Fax:321-735-4993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-27
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH257283336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2132805OtherPK
FL004473800Medicaid