Provider Demographics
NPI:1174129597
Name:SAYEM, ABU MOHAMMED (PHARMD)
Entity type:Individual
Prefix:
First Name:ABU
Middle Name:MOHAMMED
Last Name:SAYEM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 S WOODLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-7321
Mailing Address - Country:US
Mailing Address - Phone:386-624-0679
Mailing Address - Fax:386-624-0680
Practice Address - Street 1:955 S WOODLAND BLVD
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-7321
Practice Address - Country:US
Practice Address - Phone:386-624-0679
Practice Address - Fax:386-624-0680
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-10
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS43961183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist