Healthcare Provider Details

I. General information

NPI: 1053652560
Provider Name (Legal Business Name): ANGEL MALDONADO PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2013
Last Update Date: 03/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 JOHNSON ST
HOLLYWOOD FL
33021-5421
US

IV. Provider business mailing address

7441 WAYNE AVE APT 12I
MIAMI FL
33141-2541
US

V. Phone/Fax

Practice location:
  • Phone: 954-265-3058
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPS37875
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: