Provider Demographics
NPI:1730457656
Name:PAEZ, RICARDO DAVID (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:RICARDO
Middle Name:DAVID
Last Name:PAEZ
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6873 SW 159TH CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33193-3627
Mailing Address - Country:US
Mailing Address - Phone:786-547-0113
Mailing Address - Fax:
Practice Address - Street 1:6873 SW 159TH CT
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33193-3627
Practice Address - Country:US
Practice Address - Phone:786-547-0113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS35084183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS35084OtherBOARD OF PHARMACY