Provider Demographics
NPI:1295095701
Name:CANCIO, ELIA (RPH)
Entity type:Individual
Prefix:
First Name:ELIA
Middle Name:
Last Name:CANCIO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11430 NW 20TH ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33172-1845
Mailing Address - Country:US
Mailing Address - Phone:305-441-9400
Mailing Address - Fax:305-370-6287
Practice Address - Street 1:11430 NW 20TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33172-1845
Practice Address - Country:US
Practice Address - Phone:305-441-9400
Practice Address - Fax:305-370-6287
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS21273183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist