Provider Demographics
NPI:1912284902
Name:ROY, FERNANDO S (RPH)
Entity Type:Individual
Prefix:MR
First Name:FERNANDO
Middle Name:S
Last Name:ROY
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 NE 30TH ST
Mailing Address - Street 2:UNIT 801
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-4318
Mailing Address - Country:US
Mailing Address - Phone:305-321-1385
Mailing Address - Fax:
Practice Address - Street 1:480 N.E. 30 ST
Practice Address - Street 2:UNIT 801
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137
Practice Address - Country:US
Practice Address - Phone:305-321-1385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS35589183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist