Provider Demographics
NPI:1760519235
Name:MORALES, JOSE CARLOS (RPH)
Entity Type:Individual
Prefix:PROF
First Name:JOSE CARLOS
Middle Name:
Last Name:MORALES
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8465 SW 76TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-3750
Mailing Address - Country:US
Mailing Address - Phone:786-303-5501
Mailing Address - Fax:305-558-1515
Practice Address - Street 1:5945 W 25TH CT
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-4423
Practice Address - Country:US
Practice Address - Phone:305-558-7800
Practice Address - Fax:305-558-1515
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS26289183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS 26289OtherPHARMACIST LICENSEE