Provider Demographics
NPI:1093420929
Name:IGLESIAS, MARIA C (RPH)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:C
Last Name:IGLESIAS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:C
Other - Last Name:ALVAREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:12500 SW 43RD ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-4200
Mailing Address - Country:US
Mailing Address - Phone:305-803-3608
Mailing Address - Fax:
Practice Address - Street 1:1611 NW 12TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1005
Practice Address - Country:US
Practice Address - Phone:305-585-8359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-16
Last Update Date:2023-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22866183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL22866OtherPHARMACY LISENCE NUMBER