Provider Demographics
NPI:1851107460
Name:GUSTAVE, RODANA STEPHANIE (PHARMD)
Entity type:Individual
Prefix:
First Name:RODANA
Middle Name:STEPHANIE
Last Name:GUSTAVE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15315 SW 106TH TER APT 402
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-4564
Mailing Address - Country:US
Mailing Address - Phone:786-222-7260
Mailing Address - Fax:
Practice Address - Street 1:925 NE 30TH TER STE 200
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-7614
Practice Address - Country:US
Practice Address - Phone:305-245-1800
Practice Address - Fax:305-245-1848
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS67051183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist