Provider Demographics
NPI:1710225883
Name:PINO, ILEANA E (RPH)
Entity Type:Individual
Prefix:DR
First Name:ILEANA
Middle Name:E
Last Name:PINO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10201 HAMMOCKS BLVD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33196-4712
Mailing Address - Country:US
Mailing Address - Phone:305-382-7421
Mailing Address - Fax:305-382-6562
Practice Address - Street 1:10201 HAMMOCKS BLVD
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33196-4712
Practice Address - Country:US
Practice Address - Phone:305-382-7421
Practice Address - Fax:305-382-6562
Is Sole Proprietor?:No
Enumeration Date:2013-01-24
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS48405183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist