Healthcare Provider Details

I. General information

NPI: 1700166345
Provider Name (Legal Business Name): ADALYS MARLENNE RODRIGUEZ PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2011
Last Update Date: 08/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E STATE ROAD 434
LONGWOOD FL
32750-5273
US

IV. Provider business mailing address

115 E STATE ROAD 434
LONGWOOD FL
32750-5273
US

V. Phone/Fax

Practice location:
  • Phone: 407-830-7350
  • Fax: 407-830-1559
Mailing address:
  • Phone: 407-830-7350
  • Fax: 407-830-1559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS46627
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: