Provider Demographics
NPI:1427536622
Name:KANDERSACK, ALLISON (PHARMD)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:KANDERSACK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9909 NW 14TH CT
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-5925
Mailing Address - Country:US
Mailing Address - Phone:954-648-5566
Mailing Address - Fax:
Practice Address - Street 1:16205 S MILITARY TRL
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6503
Practice Address - Country:US
Practice Address - Phone:561-495-8331
Practice Address - Fax:561-495-8312
Is Sole Proprietor?:No
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH026824183500000X
FLPS46434183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist