Provider Demographics
NPI:1164741666
Name:ZALDIVAR, ALLEN KEITH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:KEITH
Last Name:ZALDIVAR
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 1:17642 SW 134TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-7162
Mailing Address - Country:US
Mailing Address - Phone:786-303-0701
Mailing Address - Fax:
Practice Address - Street 1:9701 SW 24TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-7512
Practice Address - Country:US
Practice Address - Phone:305-221-5355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-24
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41681183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist