Provider Demographics
NPI:1053659912
Name:VELAZQUEZ, GISELE (RPH, CPH)
Entity Type:Individual
Prefix:
First Name:GISELE
Middle Name:
Last Name:VELAZQUEZ
Suffix:
Gender:F
Credentials:RPH, CPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7275 SW 90TH WAY
Mailing Address - Street 2:APT G 509
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33156-8333
Mailing Address - Country:US
Mailing Address - Phone:305-815-0437
Mailing Address - Fax:
Practice Address - Street 1:7275 SW 90TH WAY
Practice Address - Street 2:APT G 509
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33156-8333
Practice Address - Country:US
Practice Address - Phone:305-815-0437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-27
Last Update Date:2013-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS37377183500000X
PR3766183500000X
FLPU68031835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric