Provider Demographics
NPI:1780085522
Name:SOTO, IVETTE (RPH)
Entity type:Individual
Prefix:
First Name:IVETTE
Middle Name:
Last Name:SOTO
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 1:7698 NW 178TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33015-6161
Mailing Address - Country:US
Mailing Address - Phone:305-467-4868
Mailing Address - Fax:
Practice Address - Street 1:645 W HALLANDALE BEACH BLVD STE 107
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-5345
Practice Address - Country:US
Practice Address - Phone:305-570-1933
Practice Address - Fax:305-570-2433
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-11
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS38831183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist