Healthcare Provider Details

I. General information

NPI: 1265364608
Provider Name (Legal Business Name): LAURA CANINO MORENO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9555 SW 162ND AVE
MIAMI FL
33196-6408
US

IV. Provider business mailing address

9555 SW 162ND AVE
MIAMI FL
33196-6408
US

V. Phone/Fax

Practice location:
  • Phone: 786-467-2650
  • Fax:
Mailing address:
  • Phone: 786-467-2650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS62998
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: