Provider Demographics
NPI:1053422873
Name:SAKALLAH-SIAM, FIDA SHAKER (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:FIDA
Middle Name:SHAKER
Last Name:SAKALLAH-SIAM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 CORAL RIDGE DR APT 204
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-4139
Mailing Address - Country:US
Mailing Address - Phone:954-755-5875
Mailing Address - Fax:954-755-5875
Practice Address - Street 1:3435 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-6605
Practice Address - Country:US
Practice Address - Phone:954-781-0442
Practice Address - Fax:954-781-8595
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0038240183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0556050690Medicare ID - Type Unspecified