Provider Demographics
NPI:1003185307
Name:SORIAL, SAWSAN S (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:SAWSAN
Middle Name:S
Last Name:SORIAL
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W STATE ROAD 436
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-4202
Mailing Address - Country:US
Mailing Address - Phone:407-389-0476
Mailing Address - Fax:407-389-0707
Practice Address - Street 1:200 W STATE ROAD 436
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-4202
Practice Address - Country:US
Practice Address - Phone:407-389-0476
Practice Address - Fax:407-389-0707
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL41933183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL41933OtherDEA