Provider Demographics
NPI:1467799536
Name:CHIRIBOGA, MARLA (RPH)
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:
Last Name:CHIRIBOGA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2871 CLAYTON CROSSING WAY
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-3426
Mailing Address - Country:US
Mailing Address - Phone:407-673-2317
Mailing Address - Fax:407-673-3775
Practice Address - Street 1:2871 CLAYTON CROSSING WAY
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-3426
Practice Address - Country:US
Practice Address - Phone:407-673-2317
Practice Address - Fax:407-673-3775
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 24268183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist