Healthcare Provider Details

I. General information

NPI: 1801530423
Provider Name (Legal Business Name): JUDITKA LOURDES AGUILAR FUSTER BSPHARM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/21/2022
Last Update Date: 04/21/2022
Certification Date: 04/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12085 W HILLSBOROUGH AVE
TAMPA FL
33635-9725
US

IV. Provider business mailing address

4733 W WATERS AVE APT 1823
TAMPA FL
33614-1463
US

V. Phone/Fax

Practice location:
  • Phone: 813-852-5270
  • Fax: 813-537-3602
Mailing address:
  • Phone: 813-475-2708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberPSI36869
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: