Provider Demographics
NPI:1093030900
Name:SIRUTIS, ALFRED J JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:ALFRED
Middle Name:J
Last Name:SIRUTIS
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:810 SAXON BLVD
Mailing Address - Street 2:ATTN: PHARMACY
Mailing Address - City:ORANGE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32763-8203
Mailing Address - Country:US
Mailing Address - Phone:386-774-1133
Mailing Address - Fax:386-774-0995
Practice Address - Street 1:810 SAXON BLVD
Practice Address - Street 2:ATTN: PHARMACY
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8203
Practice Address - Country:US
Practice Address - Phone:386-774-1133
Practice Address - Fax:386-774-0995
Is Sole Proprietor?:No
Enumeration Date:2010-04-02
Last Update Date:2010-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS31363183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist