Provider Demographics
NPI:1366831091
Name:MARSAKOVA, ANNA
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:MARSAKOVA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 CAPE HARBOUR LOOP
Mailing Address - Street 2:UNIT 105
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34212-2150
Mailing Address - Country:US
Mailing Address - Phone:239-340-0333
Mailing Address - Fax:
Practice Address - Street 1:311 CAPE HARBOUR LOOP
Practice Address - Street 2:UNIT 105
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34212-2150
Practice Address - Country:US
Practice Address - Phone:239-340-0333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-19
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPSI31179183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPSI31179OtherDEPARTMENT OF HEALTH