Provider Demographics
NPI:1083210934
Name:MARQUEZ, RAUL MANUEL JR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RAUL
Middle Name:MANUEL
Last Name:MARQUEZ
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1912 SW 17TH AVE APT 20
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-2766
Mailing Address - Country:US
Mailing Address - Phone:786-253-3351
Mailing Address - Fax:
Practice Address - Street 1:4610 S UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-3818
Practice Address - Country:US
Practice Address - Phone:954-434-2002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS60783183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist