Provider Demographics
NPI:1114545274
Name:EGUED, VANESSA
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:EGUED
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11350 SW 41ST TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-4611
Mailing Address - Country:US
Mailing Address - Phone:786-580-6173
Mailing Address - Fax:305-585-3997
Practice Address - Street 1:901 NW 17TH ST STE D
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-1135
Practice Address - Country:US
Practice Address - Phone:305-585-3996
Practice Address - Fax:305-585-3997
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRPT11578183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLRPT11578OtherFLORIDA BOARD OF PHARMACY