Provider Demographics
NPI:1477800217
Name:SIRAGUSA, ALEX JOSEPH (RPH)
Entity Type:Individual
Prefix:DR
First Name:ALEX
Middle Name:JOSEPH
Last Name:SIRAGUSA
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 1:325 N ALAFAYA TRL
Mailing Address - Street 2:TARGET PHARMACY T1760
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-7012
Mailing Address - Country:US
Mailing Address - Phone:407-482-8155
Mailing Address - Fax:
Practice Address - Street 1:325 N ALAFAYA TRL
Practice Address - Street 2:TARGET PHARMACY T1760
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-7012
Practice Address - Country:US
Practice Address - Phone:407-482-8155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-11
Last Update Date:2012-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS49526183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist