Provider Demographics
NPI:1528271442
Name:LAFFITA, MALCOM (PHARMD)
Entity type:Individual
Prefix:
First Name:MALCOM
Middle Name:
Last Name:LAFFITA
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 1:2462 SW 137TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-6330
Mailing Address - Country:US
Mailing Address - Phone:305-521-9400
Mailing Address - Fax:305-521-9401
Practice Address - Street 1:2462 SW 137TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33175-6330
Practice Address - Country:US
Practice Address - Phone:305-521-9400
Practice Address - Fax:305-521-9401
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0040110183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL021562700Medicaid