Provider Demographics
NPI:1003575614
Name:BRACERAS, WILFREDO OCTAVIO (RPH)
Entity Type:Individual
Prefix:MR
First Name:WILFREDO
Middle Name:OCTAVIO
Last Name:BRACERAS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10320 SW 166TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-1086
Mailing Address - Country:US
Mailing Address - Phone:786-691-7808
Mailing Address - Fax:
Practice Address - Street 1:13325 SW 124TH ST # 2
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-6418
Practice Address - Country:US
Practice Address - Phone:786-691-7808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS284681835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistGroup - Single Specialty