=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255510319
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RANDY J FERRETER PHARM.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2007
-----------------------------------------------------
Last Update Date | 10/25/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2616 COMMERCE PARK DR SUITE 500
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32819-8617
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-264-5100
-----------------------------------------------------
Fax | 407-264-5123
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2616 COMMERCE PARK DR SUITE 500
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32819-8617
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-264-5100
-----------------------------------------------------
Fax | 407-264-5123
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PS36103
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------