Provider Demographics
NPI:1861762205
Name:COOREY, ANITA MARIE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ANITA
Middle Name:MARIE
Last Name:COOREY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2480 US HIGHWAY 19
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY
Mailing Address - State:FL
Mailing Address - Zip Code:34691-3943
Mailing Address - Country:US
Mailing Address - Phone:727-937-3247
Mailing Address - Fax:727-943-5925
Practice Address - Street 1:2480 US HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:HOLIDAY
Practice Address - State:FL
Practice Address - Zip Code:34691-3943
Practice Address - Country:US
Practice Address - Phone:727-937-3247
Practice Address - Fax:727-943-5925
Is Sole Proprietor?:No
Enumeration Date:2012-01-02
Last Update Date:2012-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS45147183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist