Provider Demographics
NPI:1316725682
Name:CASTELLON, LELLANI MERCEDES
Entity type:Individual
Prefix:
First Name:LELLANI
Middle Name:MERCEDES
Last Name:CASTELLON
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 1:1250 NW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-3744
Mailing Address - Country:US
Mailing Address - Phone:305-547-4790
Mailing Address - Fax:
Practice Address - Street 1:1250 NW 7TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3744
Practice Address - Country:US
Practice Address - Phone:305-547-4790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS66292183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist