Provider Demographics
NPI:1033835749
Name:GARCIA DEL MORAL, LIETYS
Entity Type:Individual
Prefix:
First Name:LIETYS
Middle Name:
Last Name:GARCIA DEL MORAL
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 1:14705 SW 42ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-3981
Mailing Address - Country:US
Mailing Address - Phone:305-220-0632
Mailing Address - Fax:
Practice Address - Street 1:14705 SW 42ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-3981
Practice Address - Country:US
Practice Address - Phone:305-220-0632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS57085183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist