Provider Demographics
NPI:1932713872
Name:MAKAR, VITA
Entity Type:Individual
Prefix:
First Name:VITA
Middle Name:
Last Name:MAKAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3830 S NOVA RD STE C4
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-9205
Mailing Address - Country:US
Mailing Address - Phone:386-238-9734
Mailing Address - Fax:
Practice Address - Street 1:3830 S NOVA RD STE C4
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32127-9205
Practice Address - Country:US
Practice Address - Phone:386-238-9734
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS61529183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS61529OtherPHARMACIST
FLPS61529OtherPHARMACIST LICENSE