Provider Demographics
NPI:1861094682
Name:MANSO, GERARDO III (PHARMD)
Entity type:Individual
Prefix:DR
First Name:GERARDO
Middle Name:
Last Name:MANSO
Suffix:III
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15698 SW 53RD ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4983
Mailing Address - Country:US
Mailing Address - Phone:305-824-7839
Mailing Address - Fax:
Practice Address - Street 1:1200 W 68TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-4524
Practice Address - Country:US
Practice Address - Phone:305-824-7839
Practice Address - Fax:305-824-0269
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS552071835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS55207OtherPHARMACIST LICENSE