Provider Demographics
NPI:1508522095
Name:LAGUERRE, AUDE SCAFFA (PHARMD)
Entity Type:Individual
Prefix:
First Name:AUDE
Middle Name:SCAFFA
Last Name:LAGUERRE
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 1:1922 INNER OAK CIR APT 203
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-7040
Mailing Address - Country:US
Mailing Address - Phone:786-488-8696
Mailing Address - Fax:
Practice Address - Street 1:7340 KATHLEEN RD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33810-4495
Practice Address - Country:US
Practice Address - Phone:863-797-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS63506183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist