Provider Demographics
NPI:1376678599
Name:SOTO, LOUIS MANUEL (RPH, MIBA)
Entity Type:Individual
Prefix:MR
First Name:LOUIS
Middle Name:MANUEL
Last Name:SOTO
Suffix:
Gender:M
Credentials:RPH, MIBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2863 W BROWARD BLVD
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33312-1289
Mailing Address - Country:US
Mailing Address - Phone:786-863-5610
Mailing Address - Fax:954-252-2300
Practice Address - Street 1:2863 W BROWARD BLVD
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-1289
Practice Address - Country:US
Practice Address - Phone:786-863-5610
Practice Address - Fax:954-252-2300
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2011-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0027491305S00000X, 1835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835X0200XPharmacy Service ProvidersPharmacistOncology
No305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS0027491OtherPHARMACY LICENSE