Provider Demographics
NPI:1447241724
Name:COLLAZO, AURELIO J (RPH)
Entity Type:Individual
Prefix:MR
First Name:AURELIO
Middle Name:J
Last Name:COLLAZO
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 1:4000 SW 57TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-5318
Mailing Address - Country:US
Mailing Address - Phone:305-666-0057
Mailing Address - Fax:305-661-9653
Practice Address - Street 1:4000 SW 57TH AVE
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-5318
Practice Address - Country:US
Practice Address - Phone:305-666-8581
Practice Address - Fax:305-661-9653
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS17897183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS17897OtherFLORIDA DEPT OF HEALTH