=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437436896
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ERNESTO ELIECER MENDEZ ALVAREDO RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/12/2011
-----------------------------------------------------
Last Update Date | 11/12/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20340 OLD CUTLER RD
-----------------------------------------------------
City | CUTLER BAY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33189-1832
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-252-4277
-----------------------------------------------------
Fax | 305-242-3992
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2025 SW 84TH AVE
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33155-1121
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-742-8508
-----------------------------------------------------
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 | PS45989
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------