Provider Demographics
NPI:1538830112
Name:MUNOZ, MARLON (RPT)
Entity type:Individual
Prefix:
First Name:MARLON
Middle Name:
Last Name:MUNOZ
Suffix:
Gender:M
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 W 21ST ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33010-2613
Mailing Address - Country:US
Mailing Address - Phone:786-401-7301
Mailing Address - Fax:786-431-5975
Practice Address - Street 1:75 W 21ST ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-2613
Practice Address - Country:US
Practice Address - Phone:786-401-7301
Practice Address - Fax:786-431-5975
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRPT74984183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician