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General NPI Number Information
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NPI Number | 1669186953
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Entity Type | Individual
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Provider Name | SAMANTHA RIVAS CRESPO PHARMD
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Gender | Female
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Dates
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Enumeration Date | 01/11/2023
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Last Update Date | 01/11/2023
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Provider Practice Location Address
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Address Line | 860 AVENIDA CENTRAL
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City | LADY LAKE
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State | FL
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Zip | 32159-7701
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Country | US
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Telephone | 407-969-7560
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Fax |
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Provider Business Mailing Address
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Address Line | 303 SOUTHERN PECAN CIR UNIT 201
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City | WINTER GARDEN
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State | FL
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Zip | 34787-6347
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Country | US
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Telephone | 407-969-7560
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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 | PS65307
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License Number State | FL
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