Individual
BRIAN STALEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4928 STATE ROAD 674, WIMAUMA, FL 33598-3510
(813) 633-1463
Mailing address
2310 RAY RD, VALRICO, FL 33594-4618
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PS0028729
FL
Other
Enumeration date
10/26/2020
Last updated
10/26/2020
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