Provider Demographics
NPI:1033489539
Name:COLON, RISSELL (RPH)
Entity Type:Individual
Prefix:MRS
First Name:RISSELL
Middle Name:
Last Name:COLON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11600 S ORANGE BLOSSOM TRL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-9215
Mailing Address - Country:US
Mailing Address - Phone:407-851-8554
Mailing Address - Fax:407-240-2727
Practice Address - Street 1:11600 S ORANGE BLOSSOM TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-9215
Practice Address - Country:US
Practice Address - Phone:407-851-8554
Practice Address - Fax:407-240-2727
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-31
Last Update Date:2011-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS39052183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist