Healthcare Provider Details

I. General information

NPI: 1730440702
Provider Name (Legal Business Name): RX MARINE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2012
Last Update Date: 06/25/2025
Certification Date: 05/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5580 E. GRANT ST SUITE 100
ORLANDO FL
32822
US

IV. Provider business mailing address

5580 E. GRANT ST SUITE 100
ORLANDO FL
32822
US

V. Phone/Fax

Practice location:
  • Phone: 786-310-7099
  • Fax: 786-332-4069
Mailing address:
  • Phone: 786-310-7099
  • Fax: 786-332-4069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH26153
License Number StateFL

VIII. Authorized Official

Name: LEONARDO IVAN SIGLER
Title or Position: OWNER/PHARMACY MANAGER
Credential: RPH
Phone: 786-310-7099