Provider Demographics
NPI:1265999767
Name:LESTINI, ERICA (PHARMD)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:LESTINI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 MASSACHUSETTS AVE NE APT 214
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33703-4343
Mailing Address - Country:US
Mailing Address - Phone:727-278-1424
Mailing Address - Fax:
Practice Address - Street 1:1361 MAIN ST
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-6246
Practice Address - Country:US
Practice Address - Phone:727-281-8242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-21
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL58003183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist