Provider Demographics
NPI:1982300075
Name:FAROOQI, MOOSA MUHAMMAD
Entity Type:Individual
Prefix:
First Name:MOOSA
Middle Name:MUHAMMAD
Last Name:FAROOQI
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 1:13125 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-2759
Mailing Address - Country:US
Mailing Address - Phone:904-596-1653
Mailing Address - Fax:
Practice Address - Street 1:13125 N MAIN ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-2759
Practice Address - Country:US
Practice Address - Phone:904-596-1653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-01
Last Update Date:2023-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS64989183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist