Provider Demographics
NPI:1083161616
Name:ROA, ARELYS MARIA
Entity Type:Individual
Prefix:
First Name:ARELYS
Middle Name:MARIA
Last Name:ROA
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 1:11575 CITY HALL PROMENADE
Mailing Address - Street 2:UNIT 247
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-7589
Mailing Address - Country:US
Mailing Address - Phone:305-778-6568
Mailing Address - Fax:
Practice Address - Street 1:155 E 2ND AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-4924
Practice Address - Country:US
Practice Address - Phone:305-863-8616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS50794183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist