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General NPI Number Information
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NPI Number | 1750006656
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Entity Type | Organization
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Legal Business Name | SEMINOLE PHARMACY
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Dates
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Enumeration Date | 10/04/2022
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Last Update Date | 10/04/2022
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Provider Practice Location Address
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Address Line | 850 SEMINOLE CROSSING TRL
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City | IMMOKALEE
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State | FL
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Zip | 34142-4307
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Country | US
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Telephone | 239-867-3440
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Fax |
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Provider Business Mailing Address
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Address Line | 6401 SHERIDAN ST
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City | HOLLYWOOD
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State | FL
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Zip | 33024-4156
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Country | US
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Telephone | 954-965-1331
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | VANDHANA BHAGWAN KISWANI-BARLEY
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Credential | MD
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Telephone | 863-985-5151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0002X
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Taxonomy Name | Clinic Pharmacy
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License Number |
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License Number State |
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