Provider Demographics
NPI:1376880252
Name:RIOS, JOEL (PS36117)
Entity Type:Individual
Prefix:
First Name:JOEL
Middle Name:
Last Name:RIOS
Suffix:
Gender:M
Credentials:PS36117
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1950 SAND LAKE RD BLDG 5
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-7632
Mailing Address - Country:US
Mailing Address - Phone:407-856-2301
Mailing Address - Fax:407-856-2302
Practice Address - Street 1:3154 HANGING MOSS CIR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-7624
Practice Address - Country:US
Practice Address - Phone:407-846-7662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS36117183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist