Healthcare Provider Details

I. General information

NPI: 1295004430
Provider Name (Legal Business Name): JAYSON RODRIGUEZ PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2011
Last Update Date: 12/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 S SEMORAN BLVD
ORLANDO FL
32807-2915
US

IV. Provider business mailing address

4780 ADAIR OAK DR
ORLANDO FL
32829-8266
US

V. Phone/Fax

Practice location:
  • Phone: 407-380-6361
  • Fax: 407-380-6728
Mailing address:
  • Phone: 787-629-6775
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS44494
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: