Healthcare Provider Details

I. General information

NPI: 1285943811
Provider Name (Legal Business Name): ANJE THOMAS DEOCAMPO PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2010
Last Update Date: 05/17/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 13TH ST
SAINT CLOUD FL
34769-4206
US

IV. Provider business mailing address

2105 13TH ST
SAINT CLOUD FL
34769-4206
US

V. Phone/Fax

Practice location:
  • Phone: 407-892-3213
  • Fax:
Mailing address:
  • Phone: 407-892-3213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS46624
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: