Individual
BORA NA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
700 W OAK ST, KISSIMMEE, FL 34741-4924
(407) 518-3304
Mailing address
1298 SNUG HARBOR DR, CASSELBERRY, FL 32707-6717
(407) 729-6887
Taxonomy
Speciality
Code
Description
License number
State
3336C0002X
Clinic Pharmacy
Primary
PS58439
FL
Other
Enumeration date
04/15/2020
Last updated
04/15/2020
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