Provider Demographics
NPI:1891389433
Name:MAYER, IRIS L
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:L
Last Name:MAYER
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 1:847 OLD MARCO LN
Mailing Address - Street 2:
Mailing Address - City:MARCO ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:34145-6808
Mailing Address - Country:US
Mailing Address - Phone:210-389-8790
Mailing Address - Fax:866-732-4121
Practice Address - Street 1:847 OLD MARCO LN
Practice Address - Street 2:
Practice Address - City:MARCO ISLAND
Practice Address - State:FL
Practice Address - Zip Code:34145-6808
Practice Address - Country:US
Practice Address - Phone:210-389-8790
Practice Address - Fax:866-732-4121
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS210091835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist