Provider Demographics
NPI:1619581121
Name:RAMOS, LUIS DAVID (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:DAVID
Last Name:RAMOS
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 1:113 GAILLARDIA LOOP
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-5371
Mailing Address - Country:US
Mailing Address - Phone:904-347-9626
Mailing Address - Fax:
Practice Address - Street 1:4950 BELLE TERRE PKWY
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-8692
Practice Address - Country:US
Practice Address - Phone:386-445-5350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS61443183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist