Provider Demographics
NPI:1225514631
Name:DAGHER, WANDA ANNETTE (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:ANNETTE
Last Name:DAGHER
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:WANDA
Other - Middle Name:A
Other - Last Name:ACEVEDO (MAIDEN NAME)
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:8325 SOUTHPARK CIR STE 200
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-9075
Mailing Address - Country:US
Mailing Address - Phone:407-345-7155
Mailing Address - Fax:
Practice Address - Street 1:8325 SOUTHPARK CIR STE 200
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-9075
Practice Address - Country:US
Practice Address - Phone:407-345-7155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS26172183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS26172OtherFL PHARMACIST LICENSE NUMBER