Provider Demographics
NPI:1942803424
Name:ESTEVEZ GONZALEZ, OLAF (RPH)
Entity Type:Individual
Prefix:
First Name:OLAF
Middle Name:
Last Name:ESTEVEZ GONZALEZ
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 1:6941 CARLYLE AVE APT 202
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33141-3153
Mailing Address - Country:US
Mailing Address - Phone:305-409-4419
Mailing Address - Fax:
Practice Address - Street 1:690 NW 57TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-4815
Practice Address - Country:US
Practice Address - Phone:305-264-3485
Practice Address - Fax:305-264-1748
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS42327183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist