Provider Demographics
NPI:1497368559
Name:ASANTE, SAMUEL GAISIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:GAISIE
Last Name:ASANTE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 BEACH BLVD # 203-180
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-5120
Mailing Address - Country:US
Mailing Address - Phone:904-207-0410
Mailing Address - Fax:
Practice Address - Street 1:3035 APALACHEE PKWY
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32301-5104
Practice Address - Country:US
Practice Address - Phone:850-402-4046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS58789183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist