Provider Demographics
NPI:1629479704
Name:GUTIERREZ, ADOLFO (PHARMD)
Entity Type:Individual
Prefix:
First Name:ADOLFO
Middle Name:
Last Name:GUTIERREZ
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 1:11650 MIRAMAR PKWY
Mailing Address - Street 2:STE 101
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-5823
Mailing Address - Country:US
Mailing Address - Phone:954-378-7948
Mailing Address - Fax:
Practice Address - Street 1:11650 MIRAMAR PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-5823
Practice Address - Country:US
Practice Address - Phone:954-378-7948
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-09
Last Update Date:2014-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS52600183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist