Provider Demographics
NPI:1518682434
Name:SAMUEL, SUSMITA JASMINE (PHARMD)
Entity Type:Individual
Prefix:
First Name:SUSMITA
Middle Name:JASMINE
Last Name:SAMUEL
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 1:11118 COPPERLEFE DR
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34212-2406
Mailing Address - Country:US
Mailing Address - Phone:239-691-7475
Mailing Address - Fax:
Practice Address - Street 1:9005 US HIGHWAY 301 N
Practice Address - Street 2:
Practice Address - City:PARRISH
Practice Address - State:FL
Practice Address - Zip Code:34219-8673
Practice Address - Country:US
Practice Address - Phone:941-776-8084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-04
Last Update Date:2022-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS64951183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist