Provider Demographics
NPI:1073220638
Name:MENENDEZ CARABALLO, DAYLENE (RPH)
Entity Type:Individual
Prefix:
First Name:DAYLENE
Middle Name:
Last Name:MENENDEZ CARABALLO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:522 E 40TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-2335
Mailing Address - Country:US
Mailing Address - Phone:305-321-6701
Mailing Address - Fax:
Practice Address - Street 1:106 PONCE DE LEON BLVD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-1034
Practice Address - Country:US
Practice Address - Phone:305-442-6455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL65082183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist