Provider Demographics
NPI:1295004430
Name:RODRIGUEZ, JAYSON (PHARMD)
Entity Type:Individual
Prefix:
First Name:JAYSON
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4780 ADAIR OAK DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32829-8266
Mailing Address - Country:US
Mailing Address - Phone:787-629-6775
Mailing Address - Fax:
Practice Address - Street 1:1303 S SEMORAN BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807-2915
Practice Address - Country:US
Practice Address - Phone:407-380-6361
Practice Address - Fax:407-380-6728
Is Sole Proprietor?:No
Enumeration Date:2011-12-16
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS44494183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist