Provider Demographics
NPI:1568037547
Name:IZQUIERDO GONZALEZ, SAILY (RPH)
Entity type:Individual
Prefix:
First Name:SAILY
Middle Name:
Last Name:IZQUIERDO GONZALEZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5748 SW 40TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-5302
Mailing Address - Country:US
Mailing Address - Phone:305-661-5650
Mailing Address - Fax:305-661-5651
Practice Address - Street 1:5748 SW 40TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-5302
Practice Address - Country:US
Practice Address - Phone:305-661-5650
Practice Address - Fax:305-661-5651
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-23
Last Update Date:2021-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS60873183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist