Provider Demographics
NPI:1104388446
Name:ROCHA, YANEISY (RPH)
Entity Type:Individual
Prefix:
First Name:YANEISY
Middle Name:
Last Name:ROCHA
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 1:1480 NE MIAMI GARDENS DR
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33179-4829
Mailing Address - Country:US
Mailing Address - Phone:305-949-3508
Mailing Address - Fax:
Practice Address - Street 1:1480 NE MIAMI GARDENS DR
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33179-4829
Practice Address - Country:US
Practice Address - Phone:305-949-3508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-04
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS59046183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist