Provider Demographics
NPI:1972841559
Name:COTTINGHAM, PHYLLIS SLOEZEN
Entity Type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:SLOEZEN
Last Name:COTTINGHAM
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 1:3839 PLEASANT HILL RD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-2952
Mailing Address - Country:US
Mailing Address - Phone:407-343-7878
Mailing Address - Fax:407-343-6193
Practice Address - Street 1:3839 PLEASANT HILL RD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-2952
Practice Address - Country:US
Practice Address - Phone:407-343-7878
Practice Address - Fax:407-343-6193
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS36371183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist