Provider Demographics
NPI:1447732086
Name:STEWART, AUSTIN RANDELL JR (PHARMD)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:RANDELL
Last Name:STEWART
Suffix:JR
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 1:17 NW 105TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI SHORES
Mailing Address - State:FL
Mailing Address - Zip Code:33150-1241
Mailing Address - Country:US
Mailing Address - Phone:305-877-3130
Mailing Address - Fax:
Practice Address - Street 1:17 NW 105TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI SHORES
Practice Address - State:FL
Practice Address - Zip Code:33150-1241
Practice Address - Country:US
Practice Address - Phone:305-877-3130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-30
Last Update Date:2018-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS58350183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist