Provider Demographics
NPI:1447853825
Name:BUENAVISTA, CHERRY
Entity type:Individual
Prefix:
First Name:CHERRY
Middle Name:
Last Name:BUENAVISTA
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 1:1720 W HIGHWAY 326
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34475-2474
Mailing Address - Country:US
Mailing Address - Phone:352-351-5888
Mailing Address - Fax:
Practice Address - Street 1:1720 W HIGHWAY 326
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34475-2474
Practice Address - Country:US
Practice Address - Phone:352-351-5888
Practice Address - Fax:352-622-5004
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS37502183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist