Provider Demographics
NPI:1649662917
Name:MONTOYA, INOCENCIO (RPH)
Entity type:Individual
Prefix:MR
First Name:INOCENCIO
Middle Name:
Last Name:MONTOYA
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 1:190 MALABAR RD SW
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32907-2937
Mailing Address - Country:US
Mailing Address - Phone:321-984-2575
Mailing Address - Fax:321-984-5171
Practice Address - Street 1:190 MALABAR RD SW
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-2937
Practice Address - Country:US
Practice Address - Phone:321-984-2575
Practice Address - Fax:321-984-5171
Is Sole Proprietor?:No
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS20793183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist