Provider Demographics
NPI:1467735563
Name:CRUZ, MARIA GINA (RPH)
Entity Type:Individual
Prefix:
First Name:MARIA GINA
Middle Name:
Last Name:CRUZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:MARIA GINA
Other - Middle Name:
Other - Last Name:OLAVARIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4918 PARK ST
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32404-6646
Mailing Address - Country:US
Mailing Address - Phone:213-880-8652
Mailing Address - Fax:
Practice Address - Street 1:1402 OHIO AVE
Practice Address - Street 2:
Practice Address - City:LYNN HAVEN
Practice Address - State:FL
Practice Address - Zip Code:32444-3743
Practice Address - Country:US
Practice Address - Phone:850-265-0499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-25
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS43413183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist