Individual
AISTE SUDMANTAITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
13650 FIDDLESTICKS BLVD, FORT MYERS, FL 33912-0312
(239) 768-1413
Mailing address
13650 FIDDLESTICKS BLVD, FORT MYERS, FL 33912-0312
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PS57327
FL
Other
Enumeration date
12/04/2017
Last updated
12/04/2017
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