MEDICARE: LAURA CACERES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS54104	FL

General Provider Information

NPI Number	:	1184092611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA CACERES

Provider Business Mailing Address
First Line	:	1380 W 41ST ST APT 205
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-5926
Country	:	US
Telephone Number	:	305-776-4218
Fax Number	:

Provider Business Practice Location Address
First Line	:	1380 W 41ST ST APT 205
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33012-5926
Country	:	US
Telephone Number	:	305-776-4218
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2015
Last Update Date	:	09/15/2015

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Directions to “ LAURA CACERES ” Practice Location

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