Provider Demographics
NPI:1275842460
Name:ENFINGER, FALLON NICOLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:FALLON
Middle Name:NICOLE
Last Name:ENFINGER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5000 LAKEWOOD RANCH BLVD
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-4909
Mailing Address - Country:US
Mailing Address - Phone:941-782-5946
Mailing Address - Fax:941-782-5724
Practice Address - Street 1:700 SIXTH STREET SOUTH
Practice Address - Street 2:
Practice Address - City:ST. PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4891
Practice Address - Country:US
Practice Address - Phone:727-893-6352
Practice Address - Fax:727-553-7340
Is Sole Proprietor?:No
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS436021835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist