Provider Demographics
NPI:1881162535
Name:IGLESIAS, SUSET (RPH)
Entity type:Individual
Prefix:
First Name:SUSET
Middle Name:
Last Name:IGLESIAS
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 1:1778 PIERSIDE CIR
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-8035
Mailing Address - Country:US
Mailing Address - Phone:561-400-0494
Mailing Address - Fax:
Practice Address - Street 1:5473 NW SAINT JAMES DR
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983-3444
Practice Address - Country:US
Practice Address - Phone:772-878-6119
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-10
Last Update Date:2018-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS58315183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist