Provider Demographics
NPI:1396083747
Name:RHODEN, SHALAY S
Entity type:Individual
Prefix:
First Name:SHALAY
Middle Name:S
Last Name:RHODEN
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 1:884 CYPRESS GARDENS BLVD
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-4726
Mailing Address - Country:US
Mailing Address - Phone:863-293-2382
Mailing Address - Fax:863-293-4562
Practice Address - Street 1:884 CYPRESS GARDENS BLVD
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-4726
Practice Address - Country:US
Practice Address - Phone:863-293-2382
Practice Address - Fax:863-293-4563
Is Sole Proprietor?:No
Enumeration Date:2013-01-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS47071183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist