Provider Demographics
NPI:1205048675
Name:ASENCIO, YOLANDA (R PH)
Entity type:Individual
Prefix:
First Name:YOLANDA
Middle Name:
Last Name:ASENCIO
Suffix:
Gender:F
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2131 CROSSHAIR CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-7410
Mailing Address - Country:US
Mailing Address - Phone:407-240-7938
Mailing Address - Fax:
Practice Address - Street 1:2103 AMERICANA BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-2174
Practice Address - Country:US
Practice Address - Phone:407-438-3326
Practice Address - Fax:407-438-3284
Is Sole Proprietor?:No
Enumeration Date:2007-05-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS23846183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0556050352Medicare ID - Type UnspecifiedWINN-DIXIE 2216
FL0556050352Medicare UPIN