Provider Demographics
NPI:1710533062
Name:BUITRAGO, MARIA FERNANDA
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:FERNANDA
Last Name:BUITRAGO
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 1:5888 TIMBER VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-6771
Mailing Address - Country:US
Mailing Address - Phone:561-601-2127
Mailing Address - Fax:
Practice Address - Street 1:4849 S MILITARY TRL
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-5310
Practice Address - Country:US
Practice Address - Phone:561-304-2727
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-13
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS59687183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist