Provider Demographics
NPI:1679856397
Name:DIAZ-JANE, LAURA ISABEL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ISABEL
Last Name:DIAZ-JANE
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 1:10870 OVERSEAS HWY
Mailing Address - Street 2:
Mailing Address - City:MARATHON
Mailing Address - State:FL
Mailing Address - Zip Code:33050-3455
Mailing Address - Country:US
Mailing Address - Phone:305-743-6929
Mailing Address - Fax:305-743-9658
Practice Address - Street 1:10870 OVERSEAS HWY
Practice Address - Street 2:
Practice Address - City:MARATHON
Practice Address - State:FL
Practice Address - Zip Code:33050-3455
Practice Address - Country:US
Practice Address - Phone:305-743-6929
Practice Address - Fax:305-743-9658
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS47171183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist