=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194990309
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARIA C GUTIERREZ R.PH.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/29/2008
-----------------------------------------------------
Last Update Date | 04/29/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3197 SW 18TH ST FARMACIA JULIA DISCOUNT #2
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33145-1803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-448-6523
-----------------------------------------------------
Fax | 305-444-1535
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10200 SW 37TH TER
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33165-3856
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-553-7202
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PS18782
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------