Provider Demographics
NPI:1306183926
Name:FRIEDMAN, STANFORD LEE (RPH)
Entity Type:Individual
Prefix:
First Name:STANFORD
Middle Name:LEE
Last Name:FRIEDMAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4195 W LAKE MARY BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-2410
Mailing Address - Country:US
Mailing Address - Phone:407-328-3062
Mailing Address - Fax:407-328-3067
Practice Address - Street 1:4195 W LAKE MARY BLVD
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-2410
Practice Address - Country:US
Practice Address - Phone:407-328-3062
Practice Address - Fax:407-328-3067
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS20284183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist