Provider Demographics
NPI:1639283856
Name:BEGUIRISTAIN, EDUARDO (RPH)
Entity Type:Individual
Prefix:MR
First Name:EDUARDO
Middle Name:
Last Name:BEGUIRISTAIN
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 1:1104 W 29TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-5023
Mailing Address - Country:US
Mailing Address - Phone:305-887-0284
Mailing Address - Fax:305-887-0230
Practice Address - Street 1:1104 W 29TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-5023
Practice Address - Country:US
Practice Address - Phone:305-887-0284
Practice Address - Fax:305-887-0230
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH8741333600000X
FLPS28459183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL031031000Medicaid