Provider Demographics
NPI:1275097560
Name:NIEVES, MARIELA (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARIELA
Middle Name:
Last Name:NIEVES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 GALT OCEAN DR APT 1804
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-6537
Mailing Address - Country:US
Mailing Address - Phone:787-407-0773
Mailing Address - Fax:
Practice Address - Street 1:930 MALABAR RD SE STE 1
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-3252
Practice Address - Country:US
Practice Address - Phone:321-775-0911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-30
Last Update Date:2019-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS58770183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist