Provider Demographics
NPI:1831260587
Name:FANDETTI, MARIA CRUZ (RPH)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:CRUZ
Last Name:FANDETTI
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:MARIA
Other - Middle Name:ESTHER
Other - Last Name:FANDETTI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RPH
Mailing Address - Street 1:2436 GLASCOTT PT
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35226-6320
Mailing Address - Country:US
Mailing Address - Phone:205-941-9905
Mailing Address - Fax:954-457-7164
Practice Address - Street 1:2500 E HALLANDALE BCH BLVD
Practice Address - Street 2:BVD GET DRUGS
Practice Address - City:HALLANDALE
Practice Address - State:FL
Practice Address - Zip Code:33009
Practice Address - Country:US
Practice Address - Phone:954-457-8011
Practice Address - Fax:954-457-7164
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS18763183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist