Provider Demographics
NPI:1215516745
Name:FLEITES STASHKOVA, ALICIA (PHARMD)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:FLEITES STASHKOVA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3731 SW 87TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-4321
Mailing Address - Country:US
Mailing Address - Phone:786-328-1505
Mailing Address - Fax:
Practice Address - Street 1:10660 SW 40TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-3613
Practice Address - Country:US
Practice Address - Phone:305-221-1356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS61270183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist