Provider Demographics
NPI:1114788049
Name:PALLASIGUI, GENELLE
Entity Type:Individual
Prefix:
First Name:GENELLE
Middle Name:
Last Name:PALLASIGUI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5445 STATE ROAD 16
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-1350
Mailing Address - Country:US
Mailing Address - Phone:904-940-5556
Mailing Address - Fax:
Practice Address - Street 1:5445 STATE ROAD 16
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-1350
Practice Address - Country:US
Practice Address - Phone:813-215-0301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS66715183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist