Healthcare Provider Details

I. General information

NPI: 1316812886
Provider Name (Legal Business Name): MARANGELY PACHECORUEDA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2025
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 W COLONIAL DR
OCOEE FL
34761-3400
US

IV. Provider business mailing address

3210 RIPPLE AVE APT 202
KISSIMMEE FL
34741-8342
US

V. Phone/Fax

Practice location:
  • Phone: 407-296-1912
  • Fax:
Mailing address:
  • Phone: 762-241-7022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P2201X
TaxonomyAmbulatory Care Pharmacist
License NumberPS69574
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: