Provider Demographics
NPI:1922378157
Name:PISSOURIOS, ANITA ROSE (RPH)
Entity type:Individual
Prefix:MR
First Name:ANITA
Middle Name:ROSE
Last Name:PISSOURIOS
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 1:2199 W BUSCH BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-7565
Mailing Address - Country:US
Mailing Address - Phone:813-932-2264
Mailing Address - Fax:813-935-1555
Practice Address - Street 1:2199 W BUSCH BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-7565
Practice Address - Country:US
Practice Address - Phone:813-932-2264
Practice Address - Fax:813-935-1555
Is Sole Proprietor?:No
Enumeration Date:2012-01-04
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS26619183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist