Provider Demographics
NPI:1902344013
Name:TAWFIK, SHADY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SHADY
Middle Name:
Last Name:TAWFIK
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 FAIRWOOD CT
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-4501
Mailing Address - Country:US
Mailing Address - Phone:813-892-5369
Mailing Address - Fax:
Practice Address - Street 1:3801 MIRANDA AVE.
Practice Address - Street 2:PHARMACY 119
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304
Practice Address - Country:US
Practice Address - Phone:650-493-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-09
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS45446183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist