Provider Demographics
NPI:1225249709
Name:LEZCANO, JUAN C (CPHT)
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:C
Last Name:LEZCANO
Suffix:
Gender:M
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7592 NW 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-4108
Mailing Address - Country:US
Mailing Address - Phone:786-315-0367
Mailing Address - Fax:
Practice Address - Street 1:119 NW 29TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33127-3951
Practice Address - Country:US
Practice Address - Phone:305-573-8172
Practice Address - Fax:305-573-9575
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL280101040359392183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician