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General NPI Number Information
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NPI Number | 1063620094
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Entity Type | Individual
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Provider Name | ALYSSA W SANFORD R.PH.
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Gender | Female
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 02/08/2008
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Provider Practice Location Address
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Address Line | 405 S LAWRENCE BLVD
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City | KEYSTONE HEIGHTS
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State | FL
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Zip | 32656-9222
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Country | US
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Telephone | 352-478-2057
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Fax | 352-478-2059
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Provider Business Mailing Address
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Address Line | 658 NE 171ST ST
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City | STARKE
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State | FL
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Zip | 32091-5723
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Country | US
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Telephone | 904-966-0078
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Fax | 352-478-2059
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS32098
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License Number State | FL
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