Provider Demographics
NPI:1811244544
Name:ISEMIN, EKAETTE D (BSPHARM)
Entity type:Individual
Prefix:
First Name:EKAETTE
Middle Name:D
Last Name:ISEMIN
Suffix:
Gender:F
Credentials:BSPHARM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 HAND AVE
Mailing Address - Street 2:SUITE O
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-8194
Mailing Address - Country:US
Mailing Address - Phone:386-671-9476
Mailing Address - Fax:386-671-9478
Practice Address - Street 1:1400 HAND AVE
Practice Address - Street 2:SUITE O
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-8194
Practice Address - Country:US
Practice Address - Phone:386-671-9476
Practice Address - Fax:386-671-9478
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS28851183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist