Provider Demographics
NPI:1497829048
Name:IBARRA, MIRTHA (PHARMACIST)
Entity type:Individual
Prefix:MRS
First Name:MIRTHA
Middle Name:
Last Name:IBARRA
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7345 SW 101ST CT
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3016
Mailing Address - Country:US
Mailing Address - Phone:305-595-3295
Mailing Address - Fax:
Practice Address - Street 1:9884 SW 40TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-3912
Practice Address - Country:US
Practice Address - Phone:305-221-4711
Practice Address - Fax:305-221-8058
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 17959183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS 17959OtherPHARMACIST