Provider Demographics
NPI:1306129408
Name:ECHOLS, MAUREEN TAYLOR
Entity type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:TAYLOR
Last Name:ECHOLS
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 1:1030 NW 203RD ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33169-2309
Mailing Address - Country:US
Mailing Address - Phone:305-450-0694
Mailing Address - Fax:
Practice Address - Street 1:1610 W 49TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-2931
Practice Address - Country:US
Practice Address - Phone:305-826-3842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-25
Last Update Date:2011-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL14641183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist