Healthcare Provider Details

I. General information

NPI: 1447833199
Provider Name (Legal Business Name): MARIE SHEILLA MIRVIL RPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2021
Last Update Date: 04/30/2021
Certification Date: 04/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5734 S ORANGE BLOSSOM TRL
ORLANDO FL
32839-3916
US

IV. Provider business mailing address

734 MARGARET SQ
WINTER PARK FL
32789-1931
US

V. Phone/Fax

Practice location:
  • Phone: 321-247-4820
  • Fax: 321-247-4821
Mailing address:
  • Phone: 813-532-9676
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberRPT53043
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: