Healthcare Provider Details

I. General information

NPI: 1942436902
Provider Name (Legal Business Name): MAYELA CASTILLO PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2009
Last Update Date: 06/04/2009
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

11752 SW 15TH ST
MIAMI FL
33184-2558
US

V. Phone/Fax

Practice location:
  • Phone: 305-585-7468
  • Fax:
Mailing address:
  • Phone: 305-585-7468
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPS36955
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number42107
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: