Provider Demographics
NPI:1881377976
Name:LAWENDY, BASSEM ATEF
Entity type:Individual
Prefix:
First Name:BASSEM
Middle Name:ATEF
Last Name:LAWENDY
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 1:7815 S US HIGHWAY 17/92
Mailing Address - Street 2:
Mailing Address - City:FERN PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32730-2261
Mailing Address - Country:US
Mailing Address - Phone:407-331-0968
Mailing Address - Fax:
Practice Address - Street 1:7815 S US HIGHWAY 17/92
Practice Address - Street 2:
Practice Address - City:FERN PARK
Practice Address - State:FL
Practice Address - Zip Code:32730-2261
Practice Address - Country:US
Practice Address - Phone:407-331-0968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS65693183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist