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General NPI Number Information
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NPI Number | 1821652959
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Entity Type | Individual
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Provider Name | PEGGY SOTO-OMAR
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Gender | Female
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Dates
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Enumeration Date | 04/24/2019
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Last Update Date | 10/27/2020
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Provider Practice Location Address
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Address Line | 3990 E SR 44 UNIT 207
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City | WILDWOOD
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State | FL
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Zip | 34785-7482
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Country | US
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Telephone | 352-492-9333
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Fax | 352-399-6234
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Provider Business Mailing Address
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Address Line | 10371 HENBURY ST
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City | ORLANDO
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State | FL
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Zip | 32832-6954
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Country | US
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Telephone | 407-492-3041
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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 | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PH31701
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License Number State | FL
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