Provider Demographics
NPI:1780955302
Name:FRASER, NORMA WANHAINEN (RPH)
Entity type:Individual
Prefix:
First Name:NORMA
Middle Name:WANHAINEN
Last Name:FRASER
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3770 TAMPA RD
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-6306
Mailing Address - Country:US
Mailing Address - Phone:813-855-7885
Mailing Address - Fax:813-855-5388
Practice Address - Street 1:3770 TAMPA RD
Practice Address - Street 2:
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-6306
Practice Address - Country:US
Practice Address - Phone:813-855-7885
Practice Address - Fax:813-855-5388
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS18289183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist