Provider Demographics
NPI:1306114368
Name:PAULA, JUAN ANTONIO (RPH)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:ANTONIO
Last Name:PAULA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2614 NE 10TH CT
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33033-4712
Mailing Address - Country:US
Mailing Address - Phone:305-242-0377
Mailing Address - Fax:305-242-0410
Practice Address - Street 1:2614 NE 10TH CT
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33033-4712
Practice Address - Country:US
Practice Address - Phone:305-242-0377
Practice Address - Fax:305-242-0410
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS24638183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist