Provider Demographics
NPI:1740759158
Name:CARRERA, MADISLEIDYS (RPH)
Entity Type:Individual
Prefix:
First Name:MADISLEIDYS
Middle Name:
Last Name:CARRERA
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 1:17900 N BAY RD APT 507
Mailing Address - Street 2:
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-2734
Mailing Address - Country:US
Mailing Address - Phone:786-371-8514
Mailing Address - Fax:
Practice Address - Street 1:9050 BISCAYNE BLVD
Practice Address - Street 2:
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33138-3222
Practice Address - Country:US
Practice Address - Phone:305-751-4075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-14
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS58729183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist