Healthcare Provider Details

I. General information

NPI: 1154231603
Provider Name (Legal Business Name): MR. ANGEL LUIZ RODRIGUEZ III
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 PLEASANT HILL RD
KISSIMMEE FL
34746-2724
US

IV. Provider business mailing address

237 GRIFFORD DR
KISSIMMEE FL
34758-2618
US

V. Phone/Fax

Practice location:
  • Phone: 407-944-9030
  • Fax:
Mailing address:
  • Phone: 321-946-6044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS66909
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: