Provider Demographics
NPI:1043746704
Name:PLACIDES, DEVON SEBASTIAN
Entity Type:Individual
Prefix:
First Name:DEVON
Middle Name:SEBASTIAN
Last Name:PLACIDES
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:PO BOX 295
Mailing Address - Street 2:
Mailing Address - City:KATHLEEN
Mailing Address - State:FL
Mailing Address - Zip Code:33849-0295
Mailing Address - Country:US
Mailing Address - Phone:863-712-3945
Mailing Address - Fax:
Practice Address - Street 1:8315 SHELDON RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33615-1607
Practice Address - Country:US
Practice Address - Phone:813-886-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-02
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPSI32234183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist