Provider Demographics
NPI:1184710774
Name:PEDALINO, DEAN A (RPH CPH)
Entity type:Individual
Prefix:
First Name:DEAN
Middle Name:A
Last Name:PEDALINO
Suffix:
Gender:M
Credentials:RPH CPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9858 INDIAN KEY TRAIL
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33776
Mailing Address - Country:US
Mailing Address - Phone:727-517-3815
Mailing Address - Fax:727-595-5613
Practice Address - Street 1:9858 INDIAN KEY TRAIL
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33776
Practice Address - Country:US
Practice Address - Phone:727-517-3815
Practice Address - Fax:727-595-5613
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 19523183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist