Provider Demographics
NPI:1063743987
Name:PONCE DE LEON, YORDY JULIAN (PHARM D)
Entity type:Individual
Prefix:DR
First Name:YORDY
Middle Name:JULIAN
Last Name:PONCE DE LEON
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7167 W FLAGLER ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2601
Mailing Address - Country:US
Mailing Address - Phone:305-266-3705
Mailing Address - Fax:305-266-3706
Practice Address - Street 1:7167 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2601
Practice Address - Country:US
Practice Address - Phone:305-266-3705
Practice Address - Fax:305-266-3706
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-15
Last Update Date:2018-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS44712183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist