Provider Demographics
NPI:1235244732
Name:PULIDO, MOON M (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:MOON
Middle Name:M
Last Name:PULIDO
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19449 SW 54TH ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-6271
Mailing Address - Country:US
Mailing Address - Phone:305-308-2270
Mailing Address - Fax:
Practice Address - Street 1:1835 S PERIMETER RD
Practice Address - Street 2:SUITE # 140
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-7121
Practice Address - Country:US
Practice Address - Phone:800-558-7710
Practice Address - Fax:877-825-3737
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS36942183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist