Provider Demographics
NPI:1821336223
Name:OLAZAGASTI, MARIA FELICITA (PH)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:FELICITA
Last Name:OLAZAGASTI
Suffix:
Gender:F
Credentials:PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15771 SW 152ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33187-5417
Mailing Address - Country:US
Mailing Address - Phone:305-971-2630
Mailing Address - Fax:305-971-5123
Practice Address - Street 1:15771 SW 152ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33187-5417
Practice Address - Country:US
Practice Address - Phone:305-971-2630
Practice Address - Fax:305-971-5123
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-21
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS29220183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist