MEDICARE: MARCIO F ORELLANA

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
1	183500000X	Pharmacist	PS39798	FL

General Provider Information

NPI Number	:	1841577178
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCIO F ORELLANA

Provider Business Mailing Address
First Line	:	208 REDWOOD BARK TRAIL
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34758
Country	:	US
Telephone Number	:	407-933-7652
Fax Number	:

Provider Business Practice Location Address
First Line	:	3595 SW 22ND STREET
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33145
Country	:	US
Telephone Number	:	305-444-8349
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2011
Last Update Date	:	11/15/2011

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