Doctor Name: | JUSTIN RYAN CERAVOLO |
NPI Number: | 1144586447 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PHARM.D. |
License Number: | PSI24223 |
Business Practice Address: | 9371 Cypress Lake Dr Suite #1 Fort Myers, FL - 339194939 |
Business Phone Number: | 2394817322 |
Business Fax Number: | |
Mailing Address: | 9371 Cypress Lake Dr, Suite #1 FORT MYERS |
State: | FL |
Postal Code: | 339194939 |
Phone Number: | 2394708475 |
Fax Number: | |
NPI Enumeration Date: | 04/11/2012 |
NPI Last Update Date: | 02/19/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | PSI24223 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | FL |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |