Provider Demographics
NPI:1144604109
Name:LITAK, MARIA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:LITAK
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 1:12500 STATE ROAD 54
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-3480
Mailing Address - Country:US
Mailing Address - Phone:727-376-9490
Mailing Address - Fax:
Practice Address - Street 1:12500 STATE ROAD 54
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556
Practice Address - Country:US
Practice Address - Phone:727-376-9490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-19
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS53444183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist