Provider Demographics
NPI:1891592606
Name:BLANCO, YILENA (PHARMD)
Entity type:Individual
Prefix:
First Name:YILENA
Middle Name:
Last Name:BLANCO
Suffix:
Gender:
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10027 WINDING LAKE RD APT 204
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33351-5884
Mailing Address - Country:US
Mailing Address - Phone:305-898-7548
Mailing Address - Fax:
Practice Address - Street 1:13700 W STATE ROAD 84
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33325-5302
Practice Address - Country:US
Practice Address - Phone:954-452-3998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-27
Last Update Date:2025-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS67733183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist