Provider Demographics
NPI:1467325894
Name:HABSHY, MIRA
Entity type:Individual
Prefix:
First Name:MIRA
Middle Name:
Last Name:HABSHY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10201 BAY BREEZE CT
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33615-4261
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5505 JOHNS RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-4307
Practice Address - Country:US
Practice Address - Phone:813-644-7700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL530761835C0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835C0207XPharmacy Service ProvidersPharmacistCompounded Sterile PreparationsGroup - Single Specialty