Provider Demographics
NPI:1578845525
Name:FERNANDEZ, ROGEL (PHARM D)
Entity Type:Individual
Prefix:
First Name:ROGEL
Middle Name:
Last Name:FERNANDEZ
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4049 PINE TREE DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-3601
Mailing Address - Country:US
Mailing Address - Phone:305-535-9737
Mailing Address - Fax:
Practice Address - Street 1:4049 PINE TREE DR
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-3601
Practice Address - Country:US
Practice Address - Phone:305-535-9737
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-15
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS47149183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist