Provider Demographics
NPI:1154668002
Name:RADER, JOSEPHINE C (RPH)
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:C
Last Name:RADER
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 1:10135 SE US HIGHWAY 441
Mailing Address - Street 2:
Mailing Address - City:BELLEVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:34420-2850
Mailing Address - Country:US
Mailing Address - Phone:352-347-7100
Mailing Address - Fax:352-307-1498
Practice Address - Street 1:10135 SE US HIGHWAY 441
Practice Address - Street 2:
Practice Address - City:BELLEVIEW
Practice Address - State:FL
Practice Address - Zip Code:34420-2850
Practice Address - Country:US
Practice Address - Phone:352-347-7100
Practice Address - Fax:352-307-1498
Is Sole Proprietor?:No
Enumeration Date:2013-01-12
Last Update Date:2013-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS32731183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS32731OtherFLORIDA DEPT OF HEALTH