Provider Demographics
NPI:1265036958
Name:SUAREZ, EDGARDO (RPH)
Entity Type:Individual
Prefix:
First Name:EDGARDO
Middle Name:
Last Name:SUAREZ
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 1:11300 STATE ROAD 82
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33905-5400
Mailing Address - Country:US
Mailing Address - Phone:239-461-0147
Mailing Address - Fax:239-461-2737
Practice Address - Street 1:11300 STATE ROAD 82
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33905-5400
Practice Address - Country:US
Practice Address - Phone:239-461-0147
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS6039183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist