Provider Demographics
NPI:1619526035
Name:LEE-SHANOK, FELICITY (RPH, CP)
Entity Type:Individual
Prefix:
First Name:FELICITY
Middle Name:
Last Name:LEE-SHANOK
Suffix:
Gender:F
Credentials:RPH, CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 ORANGE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-3031
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:601 E ALTAMONTE DR STE 116
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-4802
Practice Address - Country:US
Practice Address - Phone:407-303-3438
Practice Address - Fax:407-303-3439
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-09
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS35441183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist