MEDICARE: SARA NASRALLA

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
1	183500000X	Pharmacist	PS60676	FL

General Provider Information

NPI Number	:	1902477615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA NASRALLA

Provider Business Mailing Address
First Line	:	330 S ORLANDO AVE
Second Line	:
City	:	MAITLAND
State	:	FL
Zip	:	32751-5606
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	330 S ORLANDO AVE
Second Line	:
City	:	MAITLAND
State	:	FL
Zip	:	32751-5606
Country	:	US
Telephone Number	:	407-629-4669
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2021
Last Update Date	:	07/03/2021

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Directions to “ SARA NASRALLA ” Practice Location

Language	Start Address	Practice Location

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