Provider Demographics
NPI:1962125922
Name:FERNANDEZ BLAZQUEZ, JUAN ANDRES (PHARMD)
Entity type:Individual
Prefix:
First Name:JUAN
Middle Name:ANDRES
Last Name:FERNANDEZ BLAZQUEZ
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 1:1501 SW 37TH AVE APT 1407
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-1157
Mailing Address - Country:US
Mailing Address - Phone:305-586-5808
Mailing Address - Fax:
Practice Address - Street 1:13675 SW 88TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-1324
Practice Address - Country:US
Practice Address - Phone:305-385-1035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-23
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS63542183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist