Healthcare Provider Details

I. General information

NPI: 1114883485
Provider Name (Legal Business Name): JENNIFER ALFONSO PADILLA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/31/2025
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4410 W 16TH AVE
HIALEAH FL
33012-7100
US

IV. Provider business mailing address

3581 ALTIS CIR N UNIT 3202
HIALEAH FL
33018-6083
US

V. Phone/Fax

Practice location:
  • Phone: 786-353-0085
  • Fax:
Mailing address:
  • Phone: 786-439-4993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS70036
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: