Provider Demographics
NPI:1629435961
Name:PRADO, JORGE (PHARM D)
Entity Type:Individual
Prefix:
First Name:JORGE
Middle Name:
Last Name:PRADO
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 1:4260 SW 152ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-5252
Mailing Address - Country:US
Mailing Address - Phone:305-222-8120
Mailing Address - Fax:
Practice Address - Street 1:4260 SW 152ND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-5252
Practice Address - Country:US
Practice Address - Phone:305-222-8120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-18
Last Update Date:2016-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS53873183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist