Provider Demographics
NPI:1962619726
Name:GUEVARA, JESUS ALBERTO (PHARMACIST INTERN)
Entity type:Individual
Prefix:
First Name:JESUS
Middle Name:ALBERTO
Last Name:GUEVARA
Suffix:
Gender:M
Credentials:PHARMACIST INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 MADEIRA AVE APT 8
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-3959
Mailing Address - Country:US
Mailing Address - Phone:305-726-1173
Mailing Address - Fax:
Practice Address - Street 1:236 MADEIRA AVE APT 8
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-3959
Practice Address - Country:US
Practice Address - Phone:305-726-1173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPSI17446183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician