Provider Demographics
NPI:1215205935
Name:ZACUR, ENRIQUE (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:ENRIQUE
Middle Name:
Last Name:ZACUR
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10925 SW 38TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-4443
Mailing Address - Country:US
Mailing Address - Phone:305-261-3602
Mailing Address - Fax:035-261-9152
Practice Address - Street 1:998 SW 67TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-4761
Practice Address - Country:US
Practice Address - Phone:305-261-3602
Practice Address - Fax:305-261-1952
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP16190183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist