Provider Demographics
NPI:1639892003
Name:CAGNOLA FLORES, FABIOLA ALESSANDRA
Entity Type:Individual
Prefix:
First Name:FABIOLA
Middle Name:ALESSANDRA
Last Name:CAGNOLA FLORES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 E 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-4615
Mailing Address - Country:US
Mailing Address - Phone:305-888-5598
Mailing Address - Fax:
Practice Address - Street 1:855 E 8TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-4615
Practice Address - Country:US
Practice Address - Phone:305-855-5598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS64670183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist