Provider Demographics
NPI:1649783804
Name:LUIS, RANDYEL (RPH)
Entity type:Individual
Prefix:DR
First Name:RANDYEL
Middle Name:
Last Name:LUIS
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 1:3546 W 80TH ST UNIT 101
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-7512
Mailing Address - Country:US
Mailing Address - Phone:786-985-0019
Mailing Address - Fax:
Practice Address - Street 1:24051 PEACHLAND BLVD
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33954-3714
Practice Address - Country:US
Practice Address - Phone:941-627-5704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-09
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS57256183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist