Healthcare Provider Details

I. General information

NPI: 1255418521
Provider Name (Legal Business Name): ALICIA RUVIENE CHATMAN PHARM.D.,CDE,BCADM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALICIA RUVIENE HARDY PHARM.D., CDE BC-ADM

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 03/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10496 HENBURY ST
ORLANDO FL
32832-6956
US

IV. Provider business mailing address

10496 HENBURY ST
ORLANDO FL
32832-6956
US

V. Phone/Fax

Practice location:
  • Phone: 407-289-9447
  • Fax:
Mailing address:
  • Phone: 407-289-9447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPS41636
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: