Healthcare Provider Details

I. General information

NPI: 1144847302
Provider Name (Legal Business Name): EDUARDO ANCIZAR RPHT, CPHT-ADV
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2020
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 NW 17TH ST STE D
MIAMI FL
33136-1135
US

IV. Provider business mailing address

15760 BULL RUN RD APT 170G
MIAMI LAKES FL
33014-2140
US

V. Phone/Fax

Practice location:
  • Phone: 786-717-4183
  • Fax: 305-355-2288
Mailing address:
  • Phone: 954-559-2660
  • Fax: 305-585-3995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberRPT10977
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: