Provider Demographics
NPI:1518561729
Name:ESTRADA, OLGA MARIA
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:MARIA
Last Name:ESTRADA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9540 SW 34TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-4037
Mailing Address - Country:US
Mailing Address - Phone:305-299-1096
Mailing Address - Fax:
Practice Address - Street 1:10761 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33174-1421
Practice Address - Country:US
Practice Address - Phone:305-223-3405
Practice Address - Fax:305-551-1092
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-28
Last Update Date:2020-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS27598183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist