Provider Demographics
NPI:1134720923
Name:SOLIMAN, MOHAMED ALY
Entity type:Individual
Prefix:
First Name:MOHAMED
Middle Name:ALY
Last Name:SOLIMAN
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 1:3175 CHENEY HWY
Mailing Address - Street 2:
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-5979
Mailing Address - Country:US
Mailing Address - Phone:321-268-5020
Mailing Address - Fax:321-268-5022
Practice Address - Street 1:3175 CHENEY HWY
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-5979
Practice Address - Country:US
Practice Address - Phone:321-268-5020
Practice Address - Fax:321-268-5022
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS35579183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist