Provider Demographics
NPI:1689775322
Name:GAISER, MARY (RPH)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:GAISER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14315 LINDEN DR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-6143
Mailing Address - Country:US
Mailing Address - Phone:352-688-7019
Mailing Address - Fax:352-686-9445
Practice Address - Street 1:2240 COMMERCIAL WAY
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-3810
Practice Address - Country:US
Practice Address - Phone:352-666-4600
Practice Address - Fax:352-686-9445
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS36527183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0556050749Medicare ID - Type Unspecified