Provider Demographics
NPI:1114522190
Name:REDDEN, MARCILYN NICOLE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MARCILYN
Middle Name:NICOLE
Last Name:REDDEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:MARCILYN
Other - Middle Name:NICOLE
Other - Last Name:MILLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:700 W NORVELL BRYANT HWY
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:FL
Mailing Address - Zip Code:34442-6101
Mailing Address - Country:US
Mailing Address - Phone:352-249-3143
Mailing Address - Fax:352-249-3146
Practice Address - Street 1:700 W NORVELL BRYANT HWY
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:FL
Practice Address - Zip Code:34442-6101
Practice Address - Country:US
Practice Address - Phone:352-249-3143
Practice Address - Fax:352-249-3146
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS51965183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist