Provider Demographics
NPI:1538761515
Name:KAKI, HAITHAM (RPH)
Entity type:Individual
Prefix:
First Name:HAITHAM
Middle Name:
Last Name:KAKI
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 E SUGARLAND HWY
Mailing Address - Street 2:
Mailing Address - City:CLEWISTON
Mailing Address - State:FL
Mailing Address - Zip Code:33440-3124
Mailing Address - Country:US
Mailing Address - Phone:863-983-7277
Mailing Address - Fax:863-983-7229
Practice Address - Street 1:340 E SUGARLAND HWY
Practice Address - Street 2:
Practice Address - City:CLEWISTON
Practice Address - State:FL
Practice Address - Zip Code:33440-3124
Practice Address - Country:US
Practice Address - Phone:863-983-7277
Practice Address - Fax:863-983-7229
Is Sole Proprietor?:No
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41677183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist