Provider Demographics
NPI:1376823989
Name:MIDDELA, NAVIN (RPH)
Entity Type:Individual
Prefix:MR
First Name:NAVIN
Middle Name:
Last Name:MIDDELA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 BLANDING BLVD
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-2619
Mailing Address - Country:US
Mailing Address - Phone:904-298-2100
Mailing Address - Fax:904-298-2108
Practice Address - Street 1:42 BLANDING BLVD
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-2619
Practice Address - Country:US
Practice Address - Phone:904-298-2100
Practice Address - Fax:904-298-2108
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH024259183500000X
FLPS40558183500000X
MI5302035268183500000X
TX47229183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist