Provider Demographics
NPI:1295125359
Name:SANTANA, LAUREN
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:SANTANA
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 1:4226 MADEIRA CT
Mailing Address - Street 2:#3310
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-5026
Mailing Address - Country:US
Mailing Address - Phone:941-893-8896
Mailing Address - Fax:
Practice Address - Street 1:4226 MADEIRA CT
Practice Address - Street 2:#3310
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-5026
Practice Address - Country:US
Practice Address - Phone:941-893-8896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPSI 32823183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPSI 32823OtherDEPARTMENT OF HEALTH