Provider Demographics
NPI:1215275896
Name:ALFONSO, ANLLEL
Entity type:Individual
Prefix:
First Name:ANLLEL
Middle Name:
Last Name:ALFONSO
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 1:5258 NE 6TH AVE APT 17G
Mailing Address - Street 2:
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-3342
Mailing Address - Country:US
Mailing Address - Phone:561-317-8608
Mailing Address - Fax:
Practice Address - Street 1:6405 N FEDERAL HWY STE 205
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-1414
Practice Address - Country:US
Practice Address - Phone:954-727-2176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-16
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS49654183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist