Provider Demographics
NPI:1780729871
Name:DIAZ, ART JR (BS PHARMACY)
Entity type:Individual
Prefix:MR
First Name:ART
Middle Name:
Last Name:DIAZ
Suffix:JR
Gender:M
Credentials:BS PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 SW 89TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-6753
Mailing Address - Country:US
Mailing Address - Phone:305-205-8556
Mailing Address - Fax:
Practice Address - Street 1:3900 NW 79TH AVE STE 216
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6546
Practice Address - Country:US
Practice Address - Phone:305-557-9512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS19687183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist