Provider Demographics
NPI:1710573209
Name:SAN SOUCI, PAULA THERESA (RPH)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:THERESA
Last Name:SAN SOUCI
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 1:5070 AIRPORT PULLING RD N
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34105-2414
Mailing Address - Country:US
Mailing Address - Phone:239-435-0007
Mailing Address - Fax:
Practice Address - Street 1:5070 AIRPORT PULLING RD N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34105-2414
Practice Address - Country:US
Practice Address - Phone:239-435-0007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS31844183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist