Provider Demographics
NPI:1992892640
Name:EYZAGUIRRE, LETICIA C (RPH)
Entity type:Individual
Prefix:
First Name:LETICIA
Middle Name:C
Last Name:EYZAGUIRRE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13510 SW 14TH PL
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33325-5727
Mailing Address - Country:US
Mailing Address - Phone:954-600-3420
Mailing Address - Fax:
Practice Address - Street 1:3260 DAVIE BLVD
Practice Address - Street 2:
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-2766
Practice Address - Country:US
Practice Address - Phone:954-587-3126
Practice Address - Fax:954-587-3897
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS16576183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist