Provider Demographics
NPI:1508469800
Name:FERNANDEZ SAMPER, ANATHAIS (RPH)
Entity Type:Individual
Prefix:
First Name:ANATHAIS
Middle Name:
Last Name:FERNANDEZ SAMPER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3141 W 76TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-3885
Mailing Address - Country:US
Mailing Address - Phone:305-231-8200
Mailing Address - Fax:305-557-4707
Practice Address - Street 1:3141 W 76TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-3885
Practice Address - Country:US
Practice Address - Phone:305-231-8200
Practice Address - Fax:305-557-4707
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS43146183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist