Provider Demographics
NPI:1154839918
Name:FUENTES, YANELYS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:YANELYS
Middle Name:
Last Name:FUENTES
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 1:2500 W BROWARD BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-1300
Mailing Address - Country:US
Mailing Address - Phone:954-453-6537
Mailing Address - Fax:
Practice Address - Street 1:2500 W BROWARD BLVD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-1300
Practice Address - Country:US
Practice Address - Phone:653-795-4453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-15
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS59880183500000X
FLPSI36852183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist