Provider Demographics
NPI:1427104553
Name:MADRUGA, JUAN EDITO (REGISTER PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:JUAN
Middle Name:EDITO
Last Name:MADRUGA
Suffix:
Gender:M
Credentials:REGISTER PHARMACIST
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Mailing Address - Street 1:1740 S.W.97TH.COURT.
Mailing Address - Street 2:HOME
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165
Mailing Address - Country:US
Mailing Address - Phone:305-221-7259
Mailing Address - Fax:305-221-7259
Practice Address - Street 1:528 S.W. 109TH.AVE.(SWEETEWATER PHARMACY)
Practice Address - Street 2:1740 S.W.97TH.COURT.MIAMI.FL.33165. USA.
Practice Address - City:SWEETEWATER
Practice Address - State:FL
Practice Address - Zip Code:33174
Practice Address - Country:US
Practice Address - Phone:305-552-0166
Practice Address - Fax:305-552-0165
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPS-17995183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist