Provider Demographics
NPI:1356955694
Name:LASKOS, BRADLEY J (PHARMD)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:J
Last Name:LASKOS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7725 FORDSON LN
Mailing Address - Street 2:
Mailing Address - City:WINDERMERE
Mailing Address - State:FL
Mailing Address - Zip Code:34786-6735
Mailing Address - Country:US
Mailing Address - Phone:407-435-4261
Mailing Address - Fax:
Practice Address - Street 1:2015 EDGEWATER DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-5311
Practice Address - Country:US
Practice Address - Phone:407-872-0282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS61503183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist