Provider Demographics
NPI:1023598786
Name:ALCANTARA, DAVID MANUEL (RPT)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MANUEL
Last Name:ALCANTARA
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6500 HARDING ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-4005
Mailing Address - Country:US
Mailing Address - Phone:954-678-7807
Mailing Address - Fax:
Practice Address - Street 1:5997 STIRLING RD
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-7225
Practice Address - Country:US
Practice Address - Phone:954-587-3361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL55838183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician