Provider Demographics
NPI:1659165769
Name:MIRANDA RODRIGUEZ, JORGE (PHARMD)
Entity type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:MIRANDA RODRIGUEZ
Suffix:
Gender:
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 HARPER AVA PL APT 306
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34747-2441
Mailing Address - Country:US
Mailing Address - Phone:787-908-3935
Mailing Address - Fax:
Practice Address - Street 1:36205 US HWY 27 N
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-3744
Practice Address - Country:US
Practice Address - Phone:863-422-7537
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-05
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS68444183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist