Healthcare Provider Details

I. General information

NPI: 1699072249
Provider Name (Legal Business Name): ANGEL PUCHI PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2011
Last Update Date: 02/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 NW 19TH ST STE 6
FORT LAUDERDALE FL
33311-3400
US

IV. Provider business mailing address

2323 NW 19TH ST STE 6
FORT LAUDERDALE FL
33311-3400
US

V. Phone/Fax

Practice location:
  • Phone: 954-535-0318
  • Fax: 195-435-0319
Mailing address:
  • Phone: 954-535-0318
  • Fax: 195-435-0319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPS31337
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: