Provider Demographics
NPI:1760753354
Name:CRUZ, JOSE R II (PHARMD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:R
Last Name:CRUZ
Suffix:II
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 1:13546 CHESAPEAKE PL
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34609-2070
Mailing Address - Country:US
Mailing Address - Phone:954-290-5990
Mailing Address - Fax:
Practice Address - Street 1:16200 COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34610-1351
Practice Address - Country:US
Practice Address - Phone:954-290-5990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL40823183500000X
FL3581835N0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835N0905XPharmacy Service ProvidersPharmacistNuclear