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NPI Code Detail

MEDICARE: MARILYN MERCED RANDOLPH PHARMD

MEDICARE: MARILYN MERCED RANDOLPH PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacistPS39430FL

General Provider Information

NPI Number : 1376881987
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARILYN MERCED RANDOLPH PHARMD
Provider Business Mailing Address
First Line : 4402 CURRY FORD RD
Second Line :
City : ORLANDO
State : FL
Zip : 32812-2709
Country : US
Telephone Number : 407-282-8128
Fax Number : 407-282-8158
Provider Business Practice Location Address
First Line : 4402 CURRY FORD RD
Second Line :
City : ORLANDO
State : FL
Zip : 32812-2709
Country : US
Telephone Number : 407-282-8128
Fax Number : 407-282-8158
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/17/2013
Last Update Date : 01/17/2013

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