Provider Demographics
NPI:1013684000
Name:ISKANDAR, DAVID MICHEL
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MICHEL
Last Name:ISKANDAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5820 S WILLIAMSON BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32128-6401
Mailing Address - Country:US
Mailing Address - Phone:386-366-8888
Mailing Address - Fax:
Practice Address - Street 1:5820 S WILLIAMSON DR BLVD #2
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32128
Practice Address - Country:US
Practice Address - Phone:386-366-8888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS62296183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist