Provider Demographics
NPI:1053093419
Name:IZAGUIRRE, JISSELLE (PHARMD)
Entity type:Individual
Prefix:
First Name:JISSELLE
Middle Name:
Last Name:IZAGUIRRE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 SW 16TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-1032
Mailing Address - Country:US
Mailing Address - Phone:786-609-5354
Mailing Address - Fax:
Practice Address - Street 1:9675 NW 41ST ST
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33178-2974
Practice Address - Country:US
Practice Address - Phone:305-406-3760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS65977183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist