Provider Demographics
NPI:1184220691
Name:RESTO, ANIBAL
Entity Type:Individual
Prefix:MR
First Name:ANIBAL
Middle Name:
Last Name:RESTO
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 1:3911 CARRIZO CIR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-1947
Mailing Address - Country:US
Mailing Address - Phone:407-517-8642
Mailing Address - Fax:
Practice Address - Street 1:7575 OSCEOLA POLK LN RD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33896-9112
Practice Address - Country:US
Practice Address - Phone:321-677-0531
Practice Address - Fax:321-677-0537
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS39718183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist