Healthcare Provider Details

I. General information

NPI: 1750572483
Provider Name (Legal Business Name): LIZA RIOS R.PH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2007
Last Update Date: 08/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 NW 12TH AVE
MIAMI FL
33136-1005
US

IV. Provider business mailing address

1611 NW 12TH AVE
MIAMI FL
33136-1005
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-5890
  • Fax: 305-585-0088
Mailing address:
  • Phone: 305-585-5890
  • Fax: 305-585-0088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS 34612
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: