Provider Demographics
NPI:1144847302
Name:ANCIZAR, EDUARDO (RPHT, CPHT-ADV)
Entity type:Individual
Prefix:
First Name:EDUARDO
Middle Name:
Last Name:ANCIZAR
Suffix:
Gender:M
Credentials:RPHT, CPHT-ADV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15760 BULL RUN RD APT 170G
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2140
Mailing Address - Country:US
Mailing Address - Phone:954-559-2660
Mailing Address - Fax:305-585-3995
Practice Address - Street 1:901 NW 17TH ST STE D
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1135
Practice Address - Country:US
Practice Address - Phone:786-717-4183
Practice Address - Fax:305-355-2288
Is Sole Proprietor?:No
Enumeration Date:2020-07-02
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRPT10977183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRPT10977OtherFLORIDA BOARD OF PHARMACY LICENSE
FL500107010OtherPHARMACY TECHNICIAN CERTIFICATION BOARD
MI5303019942OtherDEPARTMENT OF LICENSING AND REGULATORY AFFAIRS