Provider Demographics
NPI:1518561810
Name:URRA CASTRO PALOMINO, MARCOS JAVIER (PHARMD)
Entity Type:Individual
Prefix:
First Name:MARCOS
Middle Name:JAVIER
Last Name:URRA CASTRO PALOMINO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:MARCOS
Other - Middle Name:J
Other - Last Name:URRA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:324 INDIAN TRCE
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-2996
Mailing Address - Country:US
Mailing Address - Phone:954-349-9323
Mailing Address - Fax:
Practice Address - Street 1:324 INDIAN TRCE
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-2996
Practice Address - Country:US
Practice Address - Phone:954-349-9323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-27
Last Update Date:2020-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS55812183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist