Provider Demographics
NPI:1447718705
Name:YAMSANI, ARCHANA
Entity type:Individual
Prefix:DR
First Name:ARCHANA
Middle Name:
Last Name:YAMSANI
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 1:9050 PASEO DE VALENCIA ST
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-9663
Mailing Address - Country:US
Mailing Address - Phone:914-356-6822
Mailing Address - Fax:
Practice Address - Street 1:18911 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4734
Practice Address - Country:US
Practice Address - Phone:239-590-8820
Practice Address - Fax:239-590-8822
Is Sole Proprietor?:No
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS52579183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS52579OtherFLORIDA BOARD OF PHARMACY