Provider Demographics
NPI:1538708359
Name:MACHADO, MARYLIN (PHAMD)
Entity type:Individual
Prefix:
First Name:MARYLIN
Middle Name:
Last Name:MACHADO
Suffix:
Gender:F
Credentials:PHAMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4854 NW 7TH ST APT 502
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2188
Mailing Address - Country:US
Mailing Address - Phone:786-385-3310
Mailing Address - Fax:
Practice Address - Street 1:2250 S FERDON BLVD
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-8457
Practice Address - Country:US
Practice Address - Phone:850-682-0942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-26
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS60309183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist