Provider Demographics
NPI:1942744206
Name:POMALES, LUIS RAUL (RPH)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:RAUL
Last Name:POMALES
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 1:19326 MAJESTIC ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32833-3048
Mailing Address - Country:US
Mailing Address - Phone:407-443-2751
Mailing Address - Fax:321-804-5042
Practice Address - Street 1:19326 MAJESTIC ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32833-3048
Practice Address - Country:US
Practice Address - Phone:407-443-2751
Practice Address - Fax:321-804-5042
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2510183500000X
FL22325183500000X
PARP-032854-R183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist