Provider Demographics
NPI:1780363069
Name:MISIR, SHIVSANKAR (RPH)
Entity type:Individual
Prefix:
First Name:SHIVSANKAR
Middle Name:
Last Name:MISIR
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 1:3260 SUNDANCE CIR
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-8923
Mailing Address - Country:US
Mailing Address - Phone:239-821-0485
Mailing Address - Fax:
Practice Address - Street 1:8795 TAMIAMI TRL E # 201
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34113-3313
Practice Address - Country:US
Practice Address - Phone:239-403-0060
Practice Address - Fax:239-403-0065
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS31307183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist