Provider Demographics
NPI:1497024202
Name:RODES, GRACE (RPH)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:RODES
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 1:7108 MARBELLA CT UNIT 403
Mailing Address - Street 2:
Mailing Address - City:CAPE CANAVERAL
Mailing Address - State:FL
Mailing Address - Zip Code:32920-3794
Mailing Address - Country:US
Mailing Address - Phone:321-591-1032
Mailing Address - Fax:
Practice Address - Street 1:7108 MARBELLA CT UNIT 403
Practice Address - Street 2:
Practice Address - City:CAPE CANAVERAL
Practice Address - State:FL
Practice Address - Zip Code:32920-3794
Practice Address - Country:US
Practice Address - Phone:321-591-1032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-22
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS34648183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist