Provider Demographics
NPI:1124397492
Name:RARDIN, JESSICA L (PHARM D)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:RARDIN
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2353 OCOEE APOPKA RD
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-5301
Mailing Address - Country:US
Mailing Address - Phone:407-573-0228
Mailing Address - Fax:407-654-3263
Practice Address - Street 1:2353 OCOEE APOPKA RD
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-5301
Practice Address - Country:US
Practice Address - Phone:407-573-0228
Practice Address - Fax:407-654-3263
Is Sole Proprietor?:No
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS44369183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist