Provider Demographics
NPI:1104169986
Name:PARRADO, JEFFREY RYAN (PHARM D)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:RYAN
Last Name:PARRADO
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15209 AZRA DR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-1853
Mailing Address - Country:US
Mailing Address - Phone:813-304-5812
Mailing Address - Fax:813-926-6435
Practice Address - Street 1:15209 AZRA DR
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-1853
Practice Address - Country:US
Practice Address - Phone:813-304-5812
Practice Address - Fax:813-926-6435
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-31
Last Update Date:2013-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS36239183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS36239OtherSTATE PHARMACIST LICENSE NUMBER
250537OtherNABP#