Healthcare Provider Details

I. General information

NPI: 1578153748
Provider Name (Legal Business Name): JUAN LUIS OQUENDO RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2021
Last Update Date: 10/17/2023
Certification Date: 10/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8151 DR MARTIN LUTHER KING ST N
SAINT PETERSBURG FL
33702-4111
US

IV. Provider business mailing address

8151 DR MARTIN LUTHER KING ST N
SAINT PETERSBURG FL
33702-4111
US

V. Phone/Fax

Practice location:
  • Phone: 727-576-3826
  • Fax:
Mailing address:
  • Phone: 727-576-3826
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS36173
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: