Provider Demographics
NPI:1255406195
Name:SOTO, IVAN E (RPH)
Entity type:Individual
Prefix:
First Name:IVAN
Middle Name:E
Last Name:SOTO
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 1:5479 NW 184TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33055-5344
Mailing Address - Country:US
Mailing Address - Phone:305-624-7651
Mailing Address - Fax:305-819-0174
Practice Address - Street 1:5850 NW 183RD ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-6023
Practice Address - Country:US
Practice Address - Phone:305-819-0705
Practice Address - Fax:305-819-0174
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS28399183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist