Provider Demographics
NPI:1477217701
Name:MACHADO, ROLY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ROLY
Middle Name:
Last Name:MACHADO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1690 DUNN AVE APT 1006
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-1479
Mailing Address - Country:US
Mailing Address - Phone:904-505-8548
Mailing Address - Fax:
Practice Address - Street 1:2640 BLANDING BLVD
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-9107
Practice Address - Country:US
Practice Address - Phone:904-291-5344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL63437183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist