Provider Demographics
NPI:1952814063
Name:DEL CUETO, ALEX
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:DEL CUETO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15129 SPRINGVIEW ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-2374
Mailing Address - Country:US
Mailing Address - Phone:813-326-5161
Mailing Address - Fax:
Practice Address - Street 1:250 CITRUS TOWER BLVD
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2790
Practice Address - Country:US
Practice Address - Phone:352-241-6676
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-10
Last Update Date:2017-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS56760183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist