Provider Demographics
NPI:1821676024
Name:CAKSACKKAR, CATHY
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:CAKSACKKAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6820 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34653-2510
Mailing Address - Country:US
Mailing Address - Phone:727-226-0147
Mailing Address - Fax:
Practice Address - Street 1:WALMART NEIGHBORHOOD MARKET
Practice Address - Street 2:14344 SPRING HILL DRIVE
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34609
Practice Address - Country:US
Practice Address - Phone:352-587-6950
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS18676183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist