Provider Demographics
NPI:1629352562
Name:TORRES, RAFAEL ALBERTO (RPH)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:ALBERTO
Last Name:TORRES
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4291 SW 156TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-5242
Mailing Address - Country:US
Mailing Address - Phone:305-219-0920
Mailing Address - Fax:305-223-7996
Practice Address - Street 1:15195 SW 42ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-3949
Practice Address - Country:US
Practice Address - Phone:305-223-7895
Practice Address - Fax:305-223-7996
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0026074183500000X
COPHA-17690183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist