Provider Demographics
NPI:1174134365
Name:MAGLIOCCO, ALEXANDRA (PHARMD)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:MAGLIOCCO
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 1:2990 S FISKE BLVD APT J6
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-3953
Mailing Address - Country:US
Mailing Address - Phone:321-917-3435
Mailing Address - Fax:
Practice Address - Street 1:2605 BARNA AVE
Practice Address - Street 2:
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-5452
Practice Address - Country:US
Practice Address - Phone:321-269-7392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS55294183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist