Healthcare Provider Details

I. General information

NPI: 1114522190
Provider Name (Legal Business Name): MARCILYN NICOLE REDDEN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARCILYN NICOLE MILLS PHARMD

II. Dates (important events)

Enumeration Date: 11/30/2020
Last Update Date: 11/30/2020
Certification Date: 11/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W NORVELL BRYANT HWY
HERNANDO FL
34442-6101
US

IV. Provider business mailing address

700 W NORVELL BRYANT HWY
HERNANDO FL
34442-6101
US

V. Phone/Fax

Practice location:
  • Phone: 352-249-3143
  • Fax: 352-249-3146
Mailing address:
  • Phone: 352-249-3143
  • Fax: 352-249-3146

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS51965
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: