Provider Demographics
NPI:1124410162
Name:NASSER, SANDRA (RPH)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:NASSER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 MARTIN LUTHER KING BLVD W
Mailing Address - Street 2:
Mailing Address - City:SEFFNER
Mailing Address - State:FL
Mailing Address - Zip Code:33584-4534
Mailing Address - Country:US
Mailing Address - Phone:813-651-1588
Mailing Address - Fax:813-655-1203
Practice Address - Street 1:750 MARTIN LUTHER KING BLVD W
Practice Address - Street 2:
Practice Address - City:SEFFNER
Practice Address - State:FL
Practice Address - Zip Code:33584-4534
Practice Address - Country:US
Practice Address - Phone:813-651-1588
Practice Address - Fax:813-655-1203
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-27
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS38683183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist