Provider Demographics
NPI:1114523578
Name:MALDONADO REYES, VICTOR EMMANUEL (PHARMD)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:EMMANUEL
Last Name:MALDONADO REYES
Suffix:
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 1:125 NE 32ND ST APT 1517
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-4351
Mailing Address - Country:US
Mailing Address - Phone:787-615-2883
Mailing Address - Fax:
Practice Address - Street 1:10201 HAMMOCKS BLVD STE 112
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-3780
Practice Address - Country:US
Practice Address - Phone:305-286-8381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-09
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS53833183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist