Provider Demographics
NPI:1023391448
Name:JUAREZ, INGRID R
Entity Type:Individual
Prefix:
First Name:INGRID
Middle Name:R
Last Name:JUAREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21161 SW 92ND CT
Mailing Address - Street 2:
Mailing Address - City:CUTLER BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33189-2466
Mailing Address - Country:US
Mailing Address - Phone:305-431-8652
Mailing Address - Fax:
Practice Address - Street 1:11398 QUAIL ROOST DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-6551
Practice Address - Country:US
Practice Address - Phone:305-254-0323
Practice Address - Fax:305-254-3288
Is Sole Proprietor?:No
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS44183183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist