Provider Demographics
NPI:1669755336
Name:ISAZA, GISELLE (PHARM D)
Entity type:Individual
Prefix:DR
First Name:GISELLE
Middle Name:
Last Name:ISAZA
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11218 NW 74TH TER
Mailing Address - Street 2:
Mailing Address - City:MEDLEY
Mailing Address - State:FL
Mailing Address - Zip Code:33178-1319
Mailing Address - Country:US
Mailing Address - Phone:305-297-3659
Mailing Address - Fax:
Practice Address - Street 1:9701 SW 24TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-7512
Practice Address - Country:US
Practice Address - Phone:305-221-5355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-20
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41300183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist