Provider Demographics
NPI:1508294695
Name:VALDESPINO, EDUARDO RAFAEL (PHARMD)
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:RAFAEL
Last Name:VALDESPINO
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 1:18201 SW 12TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33194-2700
Mailing Address - Country:US
Mailing Address - Phone:305-207-2109
Mailing Address - Fax:305-207-2196
Practice Address - Street 1:18201 SW 12TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33194-2700
Practice Address - Country:US
Practice Address - Phone:305-207-2109
Practice Address - Fax:305-207-2196
Is Sole Proprietor?:No
Enumeration Date:2013-10-28
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX47033183500000X
NMRP00007548183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist