Provider Demographics
NPI:1306448816
Name:KANNUSAMY, SEKAR A
Entity type:Individual
Prefix:
First Name:SEKAR
Middle Name:A
Last Name:KANNUSAMY
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 1:562 LAKE CYPRESS CIR
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-4656
Mailing Address - Country:US
Mailing Address - Phone:727-239-9767
Mailing Address - Fax:
Practice Address - Street 1:8745 STATE ROAD 54
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34655-3006
Practice Address - Country:US
Practice Address - Phone:727-376-5545
Practice Address - Fax:727-376-5574
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-10
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS28282183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist