Provider Demographics
NPI:1760005847
Name:PELLON, YAIMA DE LA CARIDAD
Entity Type:Individual
Prefix:
First Name:YAIMA
Middle Name:DE LA CARIDAD
Last Name:PELLON
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 1:9929 DOWDEN RD UNIT 19115
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-5062
Mailing Address - Country:US
Mailing Address - Phone:305-781-7318
Mailing Address - Fax:
Practice Address - Street 1:13651 HUNTERS OAK DR STE 101
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-7681
Practice Address - Country:US
Practice Address - Phone:407-730-5998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-22
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRPT39465183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician