Provider Demographics
NPI:1376942300
Name:LABRADA-RAVELO, LUZ MILAGROS (RPH,CPH)
Entity Type:Individual
Prefix:MRS
First Name:LUZ
Middle Name:MILAGROS
Last Name:LABRADA-RAVELO
Suffix:
Gender:F
Credentials:RPH,CPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 NW 5TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33128-1616
Mailing Address - Country:US
Mailing Address - Phone:305-577-4840
Mailing Address - Fax:866-407-9460
Practice Address - Street 1:336 NW 5TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33128-1616
Practice Address - Country:US
Practice Address - Phone:305-577-4840
Practice Address - Fax:866-407-9460
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-14
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21745183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist