Provider Demographics
NPI:1639217938
Name:GONZALEZ-ABREU, MAYRA (PHARMD)
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:
Last Name:GONZALEZ-ABREU
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12219 SW 14TH LN
Mailing Address - Street 2:APT. 2308
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33184-2879
Mailing Address - Country:US
Mailing Address - Phone:305-227-8077
Mailing Address - Fax:
Practice Address - Street 1:12219 SW 14TH LN
Practice Address - Street 2:APT. 2308
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-2879
Practice Address - Country:US
Practice Address - Phone:305-227-8077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0029221183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS0029221OtherLICENSE