Provider Demographics
NPI:1811400682
Name:IZQUIERDO, ILENE (PHARMD)
Entity Type:Individual
Prefix:
First Name:ILENE
Middle Name:
Last Name:IZQUIERDO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:871 FALCON AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33166-4315
Mailing Address - Country:US
Mailing Address - Phone:305-586-2111
Mailing Address - Fax:
Practice Address - Street 1:8341 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2029
Practice Address - Country:US
Practice Address - Phone:305-266-0713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-14
Last Update Date:2017-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302040332183500000X
FLPS54433183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist