Healthcare Provider Details

I. General information

NPI: 1013848142
Provider Name (Legal Business Name): NICOLAS EMANUEL CASAROSA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4302 ALTON RD STE 2020
MIAMI BEACH FL
33140-2891
US

IV. Provider business mailing address

2451 BRICKELL AVE APT 7L
MIAMI FL
33129-2433
US

V. Phone/Fax

Practice location:
  • Phone: 305-674-2514
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835C0207X
TaxonomyCompounded Sterile Preparations Pharmacist
License NumberPS64581
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: