Provider Demographics
NPI:1003186503
Name:EMBERGER, OLIVER ALEXANDER
Entity Type:Individual
Prefix:MR
First Name:OLIVER
Middle Name:ALEXANDER
Last Name:EMBERGER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1733 FIRCREST CT
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-8167
Mailing Address - Country:US
Mailing Address - Phone:813-778-6679
Mailing Address - Fax:
Practice Address - Street 1:1733 FIRCREST CT
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33543-8167
Practice Address - Country:US
Practice Address - Phone:813-778-6679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-31
Last Update Date:2011-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL27594183500000X
FL1611835N0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835N0905XPharmacy Service ProvidersPharmacistNuclear