Provider Demographics
NPI:1508103433
Name:COLASANTI, KIMBERLY S (PHARMD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:COLASANTI
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 1:10155 W OAKLAND PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-6918
Mailing Address - Country:US
Mailing Address - Phone:954-746-1002
Mailing Address - Fax:954-748-2035
Practice Address - Street 1:10155 W OAKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-6918
Practice Address - Country:US
Practice Address - Phone:954-746-1002
Practice Address - Fax:954-748-2035
Is Sole Proprietor?:No
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41417183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist