Provider Demographics
NPI:1720356611
Name:SORIAL, NEVINE W (RPH)
Entity Type:Individual
Prefix:MRS
First Name:NEVINE
Middle Name:W
Last Name:SORIAL
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 1:977 HIGHWAY 98 E
Mailing Address - Street 2:
Mailing Address - City:DESTIN
Mailing Address - State:FL
Mailing Address - Zip Code:32541-2801
Mailing Address - Country:US
Mailing Address - Phone:850-650-4538
Mailing Address - Fax:850-650-9579
Practice Address - Street 1:977 HIGHWAY 98 E
Practice Address - Street 2:
Practice Address - City:DESTIN
Practice Address - State:FL
Practice Address - Zip Code:32541-2801
Practice Address - Country:US
Practice Address - Phone:850-650-4538
Practice Address - Fax:850-650-9579
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS00279561835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy