Provider Demographics
NPI:1740324383
Name:BERROTERAN, HAYTZA YANISSE (RPH)
Entity type:Individual
Prefix:MRS
First Name:HAYTZA
Middle Name:YANISSE
Last Name:BERROTERAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8560 ARGYLE FOREST BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-1031
Mailing Address - Country:US
Mailing Address - Phone:904-779-7700
Mailing Address - Fax:
Practice Address - Street 1:8560 ARGYLE FOREST BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-1031
Practice Address - Country:US
Practice Address - Phone:904-779-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0029547183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist