Provider Demographics
NPI:1992074744
Name:ROUDIS, JOSEPH BERNARD (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:BERNARD
Last Name:ROUDIS
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 1:3769 PLEASANT HILL RD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34746-2937
Mailing Address - Country:US
Mailing Address - Phone:407-343-0357
Mailing Address - Fax:407-343-7754
Practice Address - Street 1:3769 PLEASANT HILL RD
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34746-2937
Practice Address - Country:US
Practice Address - Phone:407-343-0357
Practice Address - Fax:407-343-7754
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-23
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS44234183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist