Provider Demographics
NPI:1699072249
Name:PUCHI, ANGEL (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:
Last Name:PUCHI
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 1:2323 NW 19TH ST STE 6
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33311-3400
Mailing Address - Country:US
Mailing Address - Phone:954-535-0318
Mailing Address - Fax:195-435-0319
Practice Address - Street 1:2323 NW 19TH ST STE 6
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33311-3400
Practice Address - Country:US
Practice Address - Phone:954-535-0318
Practice Address - Fax:195-435-0319
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS313371835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist