Provider Demographics
NPI:1871138420
Name:DESIR, RODOMIR (PHARMD)
Entity type:Individual
Prefix:DR
First Name:RODOMIR
Middle Name:
Last Name:DESIR
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 1:4205 BELFORT RD STE 1003
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-5876
Mailing Address - Country:US
Mailing Address - Phone:904-450-6330
Mailing Address - Fax:904-296-4597
Practice Address - Street 1:4205 BELFORT RD STE 1003
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-5876
Practice Address - Country:US
Practice Address - Phone:904-450-6330
Practice Address - Fax:904-296-4597
Is Sole Proprietor?:No
Enumeration Date:2019-11-07
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS42870183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS42870OtherPHARMACY LICENSE