Provider Demographics
NPI:1285359422
Name:KERSMAN, MICHAEL TODD
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:TODD
Last Name:KERSMAN
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 1:2227 WILTON PARK DR
Mailing Address - Street 2:
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-1435
Mailing Address - Country:US
Mailing Address - Phone:480-773-2253
Mailing Address - Fax:
Practice Address - Street 1:2227 WILTON PARK DR
Practice Address - Street 2:
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1435
Practice Address - Country:US
Practice Address - Phone:480-773-2253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS34476183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist