Provider Demographics
NPI:1972185965
Name:GARZON, MARY GRACE DEL ROSARIO
Entity Type:Individual
Prefix:
First Name:MARY GRACE
Middle Name:DEL ROSARIO
Last Name:GARZON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N FRANCISCO ST UNIT 231
Mailing Address - Street 2:
Mailing Address - City:CLEWISTON
Mailing Address - State:FL
Mailing Address - Zip Code:33440-2218
Mailing Address - Country:US
Mailing Address - Phone:904-444-8684
Mailing Address - Fax:
Practice Address - Street 1:1005 W SUGARLAND HWY
Practice Address - Street 2:
Practice Address - City:CLEWISTON
Practice Address - State:FL
Practice Address - Zip Code:33440-2706
Practice Address - Country:US
Practice Address - Phone:863-983-8756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-28
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS50319183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist