Provider Demographics
NPI:1902440696
Name:PRICE, SELESTE BROWN (RPH)
Entity Type:Individual
Prefix:
First Name:SELESTE
Middle Name:BROWN
Last Name:PRICE
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 1:10863 BLOOMINGDALE AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-3616
Mailing Address - Country:US
Mailing Address - Phone:813-261-3664
Mailing Address - Fax:813-261-3597
Practice Address - Street 1:10863 BLOOMINGDALE AVE
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-3616
Practice Address - Country:US
Practice Address - Phone:813-261-3664
Practice Address - Fax:813-261-3597
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-05
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS33155183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist