Provider Demographics
NPI:1316541378
Name:REICHELSON, DEBORAH ELLEN
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ELLEN
Last Name:REICHELSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5899 S ORANGE BLOSSOM TRL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32839-3917
Mailing Address - Country:US
Mailing Address - Phone:407-855-8426
Mailing Address - Fax:407-855-6931
Practice Address - Street 1:5899 S ORANGE BLOSSOM TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-3917
Practice Address - Country:US
Practice Address - Phone:407-855-8426
Practice Address - Fax:407-855-6931
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
FLPS29099183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist