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General NPI Number Information
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NPI Number | 1184176901
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Entity Type | Individual
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Provider Name | MISS GERTA AVDIA
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Gender | Female
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Dates
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Enumeration Date | 10/27/2016
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Last Update Date | 10/27/2016
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Provider Practice Location Address
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Address Line | 611 OLD BURNT STORE RD SOUTH
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City | CAPE CORAL
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State | FL
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Zip | 33991
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Country | US
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Telephone | 239-690-4939
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Fax |
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Provider Business Mailing Address
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Address Line | 3694 56TH AVE N APT A
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City | ST PETERSBURG
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State | FL
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Zip | 33714-1856
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Country | US
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Telephone | 727-238-4429
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Fax |
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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 | PS55735
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License Number State | FL
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