Provider Demographics
NPI:1235574484
Name:LOPEZ LEIROS, AGUSTIN RODOLFO (RPH)
Entity Type:Individual
Prefix:
First Name:AGUSTIN
Middle Name:RODOLFO
Last Name:LOPEZ LEIROS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3930 NW 7TH ST APT 511
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-5563
Mailing Address - Country:US
Mailing Address - Phone:786-218-5814
Mailing Address - Fax:
Practice Address - Street 1:3930 NW 7TH ST APT 511
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-5563
Practice Address - Country:US
Practice Address - Phone:786-218-5814
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-01
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9574671163W00000X
FLAPRN11023966363LF0000X
FLPS47176183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily