Provider Demographics
NPI:1790567188
Name:DE LA CRUZ RODRIGUEZ, ED L (PHARMD)
Entity Type:Individual
Prefix:
First Name:ED
Middle Name:L
Last Name:DE LA CRUZ RODRIGUEZ
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 1:7020 BAYFRONT SCENIC DR UNIT 1414
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-2209
Mailing Address - Country:US
Mailing Address - Phone:941-585-9103
Mailing Address - Fax:
Practice Address - Street 1:5350 CENTRAL FLORIDA PKWY
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32821-8772
Practice Address - Country:US
Practice Address - Phone:407-465-1139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-19
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS66448183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist