Provider Demographics
NPI:1881963171
Name:GANIO, PETER JR
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:GANIO
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17746 LONG POINT DR
Mailing Address - Street 2:
Mailing Address - City:REDINGTON SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33708-1240
Mailing Address - Country:US
Mailing Address - Phone:727-392-8261
Mailing Address - Fax:
Practice Address - Street 1:10697 ULMERTON RD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33771-3527
Practice Address - Country:US
Practice Address - Phone:727-584-5587
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS34593183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist