Provider Demographics
NPI:1669013991
Name:ADIR, MARYLEXIS
Entity Type:Individual
Prefix:
First Name:MARYLEXIS
Middle Name:
Last Name:ADIR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6217 RED RIVER CV BLDG 12 APT 107
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34202-4224
Mailing Address - Country:US
Mailing Address - Phone:239-384-4331
Mailing Address - Fax:
Practice Address - Street 1:2875 UNIVERSITY PKWY
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34243-4201
Practice Address - Country:US
Practice Address - Phone:941-358-5250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPSI39033183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist