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NPI Code Detail

MEDICARE: MANUEL DE LA CRUZ RPH

MEDICARE: MANUEL DE LA CRUZ RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist28RI02269700NJ
2183500000XPharmacistPS38531FL

General Provider Information

NPI Number : 1063056240
Entity Type Code : Individual
Provider Name (Legal Business Name) : MANUEL DE LA CRUZ RPH
Provider Business Mailing Address
First Line : 8972 NW 54TH ST
Second Line :
City : SUNRISE
State : FL
Zip : 33351-7764
Country : US
Telephone Number : 954-592-5506
Fax Number :
Provider Business Practice Location Address
First Line : 2500 W BROWARD BLVD
Second Line :
City : FT LAUDERDALE
State : FL
Zip : 33312-1300
Country : US
Telephone Number : 954-453-6537
Fax Number : 954-453-6536
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/31/2019
Last Update Date : 10/31/2019

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Directions to “ MANUEL DE LA CRUZ RPH” Practice Location

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