Provider Demographics
NPI:1427464338
Name:BANNATYNE, RICARDO E (PHARMD)
Entity type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:E
Last Name:BANNATYNE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 S CHICKASAW TRL
Mailing Address - Street 2:SUITE 381
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-7801
Mailing Address - Country:US
Mailing Address - Phone:407-538-0038
Mailing Address - Fax:
Practice Address - Street 1:509 S CHICKASAW TRL
Practice Address - Street 2:SUITE 381
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-7801
Practice Address - Country:US
Practice Address - Phone:407-538-0038
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-11
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS25685183500000X
FLPU4000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist