Provider Demographics
NPI:1356851604
Name:CRESPO, LISANDRA (PHARMD)
Entity Type:Individual
Prefix:
First Name:LISANDRA
Middle Name:
Last Name:CRESPO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14135 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-6331
Mailing Address - Country:US
Mailing Address - Phone:305-989-1115
Mailing Address - Fax:
Practice Address - Street 1:4240 53RD AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-8097
Practice Address - Country:US
Practice Address - Phone:941-758-4093
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-01
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS61997183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS61997OtherLICENSE NUMBER