Healthcare Provider Details

I. General information

NPI: 1437778792
Provider Name (Legal Business Name): RIGUIN ZENGOTITA PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2020
Last Update Date: 09/29/2022
Certification Date: 09/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 FLORIDA 20
FLORIDA FL
32148
US

IV. Provider business mailing address

1213 FLORIDA 20
INTERLACHEN FL
32148-5140
US

V. Phone/Fax

Practice location:
  • Phone: 386-684-4914
  • Fax:
Mailing address:
  • Phone: 386-684-4914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH240228
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPS64500
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: