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NPI Code Detail

MEDICARE: BRADLEY J LASKOS PHARMD

MEDICARE: BRADLEY J LASKOS PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacistPS61503FL

General Provider Information

NPI Number : 1356955694
Entity Type Code : Individual
Provider Name (Legal Business Name) : BRADLEY J LASKOS PHARMD
Provider Business Mailing Address
First Line : 7725 FORDSON LN
Second Line :
City : WINDERMERE
State : FL
Zip : 34786-6735
Country : US
Telephone Number : 407-435-4261
Fax Number :
Provider Business Practice Location Address
First Line : 2015 EDGEWATER DR
Second Line :
City : ORLANDO
State : FL
Zip : 32804-5311
Country : US
Telephone Number : 407-872-0282
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/03/2020
Last Update Date : 09/03/2020

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