Provider Demographics
NPI:1447833199
Name:MIRVIL, MARIE SHEILLA (RPT)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:SHEILLA
Last Name:MIRVIL
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:734 MARGARET SQ
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-1931
Mailing Address - Country:US
Mailing Address - Phone:813-532-9676
Mailing Address - Fax:
Practice Address - Street 1:5734 S ORANGE BLOSSOM TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-3916
Practice Address - Country:US
Practice Address - Phone:321-247-4820
Practice Address - Fax:321-247-4821
Is Sole Proprietor?:No
Enumeration Date:2021-04-30
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRPT53043183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician