Provider Demographics
NPI:1619212289
Name:ZISS, CARMEN LEE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:LEE
Last Name:ZISS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3693 OAKDALE CIR
Mailing Address - Street 2:APT 101
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-8097
Mailing Address - Country:US
Mailing Address - Phone:407-482-8155
Mailing Address - Fax:
Practice Address - Street 1:325 N ALAFAYA TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-7012
Practice Address - Country:US
Practice Address - Phone:407-482-8155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-07
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS49873183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist