Provider Demographics
NPI:1750974432
Name:ISSERMAN, MICHAEL MARK (RPH)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:MARK
Last Name:ISSERMAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 E NINE MILE RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32534-3136
Mailing Address - Country:US
Mailing Address - Phone:850-475-1000
Mailing Address - Fax:850-473-9633
Practice Address - Street 1:1 E NINE MILE RD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32534-3136
Practice Address - Country:US
Practice Address - Phone:850-475-1000
Practice Address - Fax:850-473-9633
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-14
Last Update Date:2021-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS24314183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist