Healthcare Provider Details

I. General information

NPI: 1124397492
Provider Name (Legal Business Name): JESSICA L RARDIN PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2011
Last Update Date: 12/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2353 OCOEE APOPKA RD
OCOEE FL
34761-5301
US

IV. Provider business mailing address

2353 OCOEE APOPKA RD
OCOEE FL
34761-5301
US

V. Phone/Fax

Practice location:
  • Phone: 407-573-0228
  • Fax: 407-654-3263
Mailing address:
  • Phone: 407-573-0228
  • Fax: 407-654-3263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS44369
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: