Provider Demographics
NPI:1104108919
Name:IRIZARRY, JOSE A
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:A
Last Name:IRIZARRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6770 FOREST HILL BLVD
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33413-3322
Mailing Address - Country:US
Mailing Address - Phone:561-964-6666
Mailing Address - Fax:
Practice Address - Street 1:6770 FOREST HILL BLVD
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33413-3322
Practice Address - Country:US
Practice Address - Phone:561-964-6666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2011-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FMPS 0258441835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy