Provider Demographics
NPI:1538407226
Name:GARCIA, ROBERTO JR
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:
Last Name:GARCIA
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 N 19TH ST
Mailing Address - Street 2:
Mailing Address - City:IMMOKALEE
Mailing Address - State:FL
Mailing Address - Zip Code:34142-3345
Mailing Address - Country:US
Mailing Address - Phone:239-247-2582
Mailing Address - Fax:
Practice Address - Street 1:309 N 19TH ST
Practice Address - Street 2:
Practice Address - City:IMMOKALEE
Practice Address - State:FL
Practice Address - Zip Code:34142-3345
Practice Address - Country:US
Practice Address - Phone:239-247-2582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-30
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS49826183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist