Provider Demographics
NPI:1588008049
Name:SESTITO, CARL V (RPH)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:V
Last Name:SESTITO
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24051 PEACHLAND BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33954
Mailing Address - Country:US
Mailing Address - Phone:941-627-5704
Mailing Address - Fax:
Practice Address - Street 1:125 CRESTVIEW DR
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34223-4215
Practice Address - Country:US
Practice Address - Phone:540-226-0835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-26
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS48855183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist