Provider Demographics
NPI:1356397145
Name:BUSATTO, MICHAEL ROGER (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ROGER
Last Name:BUSATTO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9386 SW 21ST ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-8108
Mailing Address - Country:US
Mailing Address - Phone:305-220-8490
Mailing Address - Fax:
Practice Address - Street 1:3501 SW 160TH AVE
Practice Address - Street 2:3RD FLOOR PHARMACY DEPARTMENT
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-4695
Practice Address - Country:US
Practice Address - Phone:305-626-5614
Practice Address - Fax:305-370-6249
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 20876183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist