Provider Demographics
NPI:1396464087
Name:DE CASTRO RODRIGUEZ, ELEANA
Entity type:Individual
Prefix:
First Name:ELEANA
Middle Name:
Last Name:DE CASTRO RODRIGUEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1167 NW 124TH CT APT 205
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33182-2449
Mailing Address - Country:US
Mailing Address - Phone:305-542-9031
Mailing Address - Fax:
Practice Address - Street 1:13896 SW 56TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-6021
Practice Address - Country:US
Practice Address - Phone:305-387-2415
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS63189183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS63189OtherFLORIDA BOARD OF PHARMACY