Provider Demographics
NPI:1013598119
Name:CANCEL, ANDRES A (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANDRES
Middle Name:A
Last Name:CANCEL
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 1:498 NW 165TH STREET RD APT D404
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33169-6454
Mailing Address - Country:US
Mailing Address - Phone:954-203-6851
Mailing Address - Fax:
Practice Address - Street 1:498 NW 165TH STREET RD APT D404
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33169-6454
Practice Address - Country:US
Practice Address - Phone:954-203-6851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS60932183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist