Healthcare Provider Details

I. General information

NPI: 1790054997
Provider Name (Legal Business Name): ANDREW ZAGORSKI JR. RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2011
Last Update Date: 12/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 E BURLEIGH BLVD
TAVARES FL
32778-2208
US

IV. Provider business mailing address

680 E BURLEIGH BLVD
TAVARES FL
32778-2208
US

V. Phone/Fax

Practice location:
  • Phone: 352-253-0289
  • Fax:
Mailing address:
  • Phone: 352-253-0289
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS21140
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: