Provider Demographics
NPI:1689421729
Name:MISHRIKY, FADY
Entity type:Individual
Prefix:
First Name:FADY
Middle Name:
Last Name:MISHRIKY
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 1:9310 SOUTHPARK CENTER LOOP
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-8634
Mailing Address - Country:US
Mailing Address - Phone:866-249-1556
Mailing Address - Fax:
Practice Address - Street 1:9310 SOUTHPARK CENTER LOOP
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8634
Practice Address - Country:US
Practice Address - Phone:866-249-1556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-06
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS66970183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist