Provider Demographics
NPI:1780289520
Name:ALONSO-ROTH, ELSA JACQUELINE (PHARMACIST)
Entity type:Individual
Prefix:
First Name:ELSA
Middle Name:JACQUELINE
Last Name:ALONSO-ROTH
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 ESTEPONA AVE
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2927
Mailing Address - Country:US
Mailing Address - Phone:305-554-1121
Mailing Address - Fax:305-554-9032
Practice Address - Street 1:13830 SW 8TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33184-3033
Practice Address - Country:US
Practice Address - Phone:305-554-1121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS23582183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS23582OtherNABP