Provider Demographics
NPI:1083983266
Name:PADILLA, BLANCA LISA (RPH)
Entity Type:Individual
Prefix:MS
First Name:BLANCA
Middle Name:LISA
Last Name:PADILLA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3430 CAMBRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-4912
Mailing Address - Country:US
Mailing Address - Phone:941-371-5278
Mailing Address - Fax:
Practice Address - Street 1:3601 BEE RIDGE RD
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-1002
Practice Address - Country:US
Practice Address - Phone:941-921-4681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-18
Last Update Date:2011-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS36468183500000X
NJ28RI03337800183500000X
IL051.291238183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist