Provider Demographics
NPI:1477624047
Name:JIMENEZ, PEDRO LUIS (PHARMD)
Entity Type:Individual
Prefix:
First Name:PEDRO
Middle Name:LUIS
Last Name:JIMENEZ
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10560 NW 6TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-3937
Mailing Address - Country:US
Mailing Address - Phone:305-343-1604
Mailing Address - Fax:
Practice Address - Street 1:12107 SW 152ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-1509
Practice Address - Country:US
Practice Address - Phone:305-969-2589
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0028486183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0556050501Medicare ID - Type Unspecified