Provider Demographics
NPI:1649016759
Name:ROQUE RECIO, RAFAEL A
Entity type:Individual
Prefix:
First Name:RAFAEL
Middle Name:A
Last Name:ROQUE RECIO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6352 NW 31ST CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33147-4012
Mailing Address - Country:US
Mailing Address - Phone:786-370-1178
Mailing Address - Fax:
Practice Address - Street 1:3251 E 2ND AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-3285
Practice Address - Country:US
Practice Address - Phone:305-888-3364
Practice Address - Fax:305-888-4049
Is Sole Proprietor?:No
Enumeration Date:2024-07-08
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS65598183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist