Provider Demographics
NPI:1487774287
Name:PIEDRA, ONELIO (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ONELIO
Middle Name:
Last Name:PIEDRA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:374 S.W 159 LANE
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33027
Mailing Address - Country:US
Mailing Address - Phone:954-432-5967
Mailing Address - Fax:
Practice Address - Street 1:15859 PINES BLVD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33027
Practice Address - Country:US
Practice Address - Phone:954-443-2149
Practice Address - Fax:954-443-2150
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 25001183500000X
FLPH 16344183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1085023Medicare UPIN
FL0556050689Medicare ID - Type UnspecifiedWINN-DIXIE PHARMACY #0278