Provider Demographics
NPI:1306569280
Name:SIDAOUI, SARA MARIA (RPH)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:MARIA
Last Name:SIDAOUI
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 1:8040 MEDITERRANEAN DR
Mailing Address - Street 2:
Mailing Address - City:ESTERO
Mailing Address - State:FL
Mailing Address - Zip Code:33928-8304
Mailing Address - Country:US
Mailing Address - Phone:239-495-4921
Mailing Address - Fax:239-495-4931
Practice Address - Street 1:8040 MEDITERRANEAN DR
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-8304
Practice Address - Country:US
Practice Address - Phone:239-495-4921
Practice Address - Fax:239-495-4931
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS63616183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist