Provider Demographics
NPI:1376026922
Name:UDOGU, FELICIA MARIETA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:FELICIA
Middle Name:MARIETA
Last Name:UDOGU
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10645 EGRET HAVEN LN
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33578-3361
Mailing Address - Country:US
Mailing Address - Phone:813-956-8201
Mailing Address - Fax:
Practice Address - Street 1:10645 EGRET HAVEN LN
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-3361
Practice Address - Country:US
Practice Address - Phone:813-956-8201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-10
Last Update Date:2018-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS56771183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLA1048364803OtherAVMED