Provider Demographics
NPI:1063893550
Name:LEDINA, MICHAEL (R PH)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:LEDINA
Suffix:
Gender:M
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 1:220 NW 116TH TER
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-5026
Mailing Address - Country:US
Mailing Address - Phone:954-592-9106
Mailing Address - Fax:954-755-7969
Practice Address - Street 1:220 NW 116TH TER
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-5026
Practice Address - Country:US
Practice Address - Phone:954-592-9106
Practice Address - Fax:954-755-7969
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-10
Last Update Date:2015-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS20056183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist