MEDICARE: DR. DEIZENMAI N GEH PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS51226	FL

General Provider Information

NPI Number	:	1356826911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEIZENMAI N GEH PHARMD

Provider Business Mailing Address
First Line	:	5250 BEAR CORN RUN
Second Line	:
City	:	PORT ORANGE
State	:	FL
Zip	:	32128-7532
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1905 N NOVA RD
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32117-1421
Country	:	US
Telephone Number	:	386-672-8955
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2018
Last Update Date	:	09/30/2018

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