Provider Demographics
NPI:1700822434
Name:DE HOSTOS, ELIZABETH (PHARM D)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:DE HOSTOS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:245 W 39TH PL
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-4337
Mailing Address - Country:US
Mailing Address - Phone:305-821-8878
Mailing Address - Fax:
Practice Address - Street 1:2475 E 5TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-3917
Practice Address - Country:US
Practice Address - Phone:305-694-1886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0032920183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist