Provider Demographics
NPI:1528675352
Name:BLANCO, MAYRA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MAYRA
Middle Name:
Last Name:BLANCO
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 W FLAGLER ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-1335
Mailing Address - Country:US
Mailing Address - Phone:056-441-9943
Mailing Address - Fax:
Practice Address - Street 1:2700 W FLAGLER ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-1335
Practice Address - Country:US
Practice Address - Phone:305-644-1994
Practice Address - Fax:305-644-9964
Is Sole Proprietor?:No
Enumeration Date:2020-09-25
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS444961835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist