Provider Demographics
NPI:1245718543
Name:EASTMAN, SERGIO DANIEL (PHARMD, RPH)
Entity type:Individual
Prefix:DR
First Name:SERGIO
Middle Name:DANIEL
Last Name:EASTMAN
Suffix:
Gender:M
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4173 S TAMIAMI TRL
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-5111
Mailing Address - Country:US
Mailing Address - Phone:941-408-0787
Mailing Address - Fax:
Practice Address - Street 1:4173 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-5111
Practice Address - Country:US
Practice Address - Phone:941-408-0787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-30
Last Update Date:2020-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS57882183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist