Provider Demographics
NPI:1235657537
Name:PESSA, KURT (PHARMD)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:
Last Name:PESSA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 EVERNIA ST APT 902
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401-5685
Mailing Address - Country:US
Mailing Address - Phone:321-298-2325
Mailing Address - Fax:
Practice Address - Street 1:4860 DONALD ROSS RD
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33418-7201
Practice Address - Country:US
Practice Address - Phone:561-598-5990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-07
Last Update Date:2017-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS57062183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty