Healthcare Provider Details

I. General information

NPI: 1659421576
Provider Name (Legal Business Name): SIMONE ANDREA MINTO-PENNANT PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 07/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 RAYMOND ST
ORLANDO FL
32803-8208
US

IV. Provider business mailing address

178 SEVILLE CHASE DR
WINTER SPRINGS FL
32708-3920
US

V. Phone/Fax

Practice location:
  • Phone: 407-599-1547
  • Fax:
Mailing address:
  • Phone: 407-699-1484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberPS32843
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: