Provider Demographics
NPI:1043846819
Name:SIDDIQI, BILAL
Entity type:Individual
Prefix:
First Name:BILAL
Middle Name:
Last Name:SIDDIQI
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 1:35800 US HWY 27 N
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-3735
Mailing Address - Country:US
Mailing Address - Phone:863-422-6661
Mailing Address - Fax:
Practice Address - Street 1:35800 US HWY 27 N
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-3735
Practice Address - Country:US
Practice Address - Phone:863-422-6661
Practice Address - Fax:863-422-8472
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-12
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH16249183500000X
FLPS60360183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS60360OtherFL BOARD OF PHARMACY
FL106502500Medicaid