Provider Demographics
NPI:1376266650
Name:RUSH, SIERRA (PHARMD)
Entity Type:Individual
Prefix:
First Name:SIERRA
Middle Name:
Last Name:RUSH
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 1:14561 PALM BEACH BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33905-2311
Mailing Address - Country:US
Mailing Address - Phone:239-202-5163
Mailing Address - Fax:
Practice Address - Street 1:13650 FIDDLESTICKS BLVD
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-0395
Practice Address - Country:US
Practice Address - Phone:239-768-1413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-22
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS64884183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist