Provider Demographics
NPI:1124363965
Name:FREGEOLLE, TINA CHIARA (PHARMD)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:CHIARA
Last Name:FREGEOLLE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16690 SWEET 88 ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-1002
Mailing Address - Country:US
Mailing Address - Phone:305-408-7956
Mailing Address - Fax:
Practice Address - Street 1:16690 SW 88TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-1002
Practice Address - Country:US
Practice Address - Phone:305-408-7956
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-05
Last Update Date:2015-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS50000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist