Provider Demographics
NPI:1164823423
Name:PARDO, WINIFRED
Entity Type:Individual
Prefix:
First Name:WINIFRED
Middle Name:
Last Name:PARDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 BAPTIST WAY
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-7600
Mailing Address - Country:US
Mailing Address - Phone:786-243-8529
Mailing Address - Fax:
Practice Address - Street 1:975 BAPTIST WAT
Practice Address - Street 2:
Practice Address - City:HOMESTAED
Practice Address - State:FL
Practice Address - Zip Code:33176
Practice Address - Country:US
Practice Address - Phone:786-243-8529
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS280401835P0018X
FL31315261835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist