Provider Demographics
NPI:1710534680
Name:TOLOZA, IAN ADRIAN
Entity Type:Individual
Prefix:
First Name:IAN
Middle Name:ADRIAN
Last Name:TOLOZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4202 SW 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-5668
Mailing Address - Country:US
Mailing Address - Phone:239-462-8899
Mailing Address - Fax:
Practice Address - Street 1:4202 SW 14TH AVE
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914-5668
Practice Address - Country:US
Practice Address - Phone:239-462-8899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-24
Last Update Date:2019-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS59825183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist