Provider Demographics
NPI:1912501826
Name:SUNDERMAN, IRENE LOPES (RPH)
Entity Type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:LOPES
Last Name:SUNDERMAN
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 1:13998 WALSINGHAM RD
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33774
Mailing Address - Country:US
Mailing Address - Phone:727-595-2521
Mailing Address - Fax:727-596-8046
Practice Address - Street 1:13998 WALSINGHAM RD
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33774-3224
Practice Address - Country:US
Practice Address - Phone:727-595-2521
Practice Address - Fax:727-596-8046
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL30872183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist