Provider Demographics
NPI:1801179031
Name:CRESPO, LUIS A (RPH)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:A
Last Name:CRESPO
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 1:524 JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-6303
Mailing Address - Country:US
Mailing Address - Phone:305-531-7688
Mailing Address - Fax:305-531-9912
Practice Address - Street 1:524 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-6303
Practice Address - Country:US
Practice Address - Phone:305-531-7688
Practice Address - Fax:305-531-9912
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS24510183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist