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General NPI Number Information
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NPI Number | 1003575614
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Entity Type | Individual
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Provider Name | WILFREDO OCTAVIO BRACERAS RPH
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Gender | Male
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Dates
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Enumeration Date | 12/10/2021
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Last Update Date | 12/10/2021
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Provider Practice Location Address
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Address Line | 13325 SW 124TH ST # 2
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City | MIAMI
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State | FL
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Zip | 33186-6418
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Country | US
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Telephone | 786-691-7808
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Fax |
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Provider Business Mailing Address
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Address Line | 10320 SW 166TH CT
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City | MIAMI
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State | FL
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Zip | 33196-1086
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Country | US
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Telephone | 786-691-7808
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | PS28468
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License Number State | FL
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