Provider Demographics
NPI:1013769835
Name:PIEDRA, RENE FABIAN (RPH)
Entity Type:Individual
Prefix:
First Name:RENE
Middle Name:FABIAN
Last Name:PIEDRA
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 1:1500 SW 57TH AVE
Mailing Address - Street 2:
Mailing Address - City:WEST MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-5722
Mailing Address - Country:US
Mailing Address - Phone:305-265-8019
Mailing Address - Fax:
Practice Address - Street 1:1500 SW 57TH AVE
Practice Address - Street 2:
Practice Address - City:WEST MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-5722
Practice Address - Country:US
Practice Address - Phone:305-265-8019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-04
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS66843183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist