Provider Demographics
NPI:1548791411
Name:CANDIA, RODOLFO RENE (RPH)
Entity Type:Individual
Prefix:MR
First Name:RODOLFO
Middle Name:RENE
Last Name:CANDIA
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 1:1635 BARTOW RD
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33801-6585
Mailing Address - Country:US
Mailing Address - Phone:863-686-5161
Mailing Address - Fax:863-683-0788
Practice Address - Street 1:1635 BARTOW RD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33801-6585
Practice Address - Country:US
Practice Address - Phone:863-686-5161
Practice Address - Fax:863-683-0788
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2021-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS56093183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist