Healthcare Provider Details

I. General information

NPI: 1093705253
Provider Name (Legal Business Name): JANET LEA DALLMAN CPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6106 55TH TER E
BRADENTON FL
34203-9762
US

IV. Provider business mailing address

6106 55TH TER E
BRADENTON FL
34203-9762
US

V. Phone/Fax

Practice location:
  • Phone: 941-758-7688
  • Fax: 941-758-7688
Mailing address:
  • Phone: 941-758-7688
  • Fax: 941-758-7688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberPU4382
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS29198
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: