Provider Demographics
NPI:1316219744
Name:MOSAK, GERALD SHELDON (RPH)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:SHELDON
Last Name:MOSAK
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 1:15806 FENTON PLACE
Mailing Address - Street 2:HAMPTON LAKES
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33618
Mailing Address - Country:US
Mailing Address - Phone:813-269-2136
Mailing Address - Fax:
Practice Address - Street 1:12807 US HIGHWAY 301
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33525-5812
Practice Address - Country:US
Practice Address - Phone:352-567-9606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 34530183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist