Provider Demographics
NPI:1154183275
Name:BANAAG, ALEXA NICOLE MUSNGI (PHARMD, CPH)
Entity type:Individual
Prefix:
First Name:ALEXA NICOLE
Middle Name:MUSNGI
Last Name:BANAAG
Suffix:
Gender:F
Credentials:PHARMD, CPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6150 150TH AVE N STE MAPS
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33760-2138
Mailing Address - Country:US
Mailing Address - Phone:727-507-4673
Mailing Address - Fax:727-507-4674
Practice Address - Street 1:13800 66TH ST
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-4909
Practice Address - Country:US
Practice Address - Phone:727-499-7228
Practice Address - Fax:727-507-4202
Is Sole Proprietor?:No
Enumeration Date:2024-01-24
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPU9731183500000X
FLPS64572183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist