Healthcare Provider Details

I. General information

NPI: 1689879090
Provider Name (Legal Business Name): DOREL SUBONI PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 E DANIA BEACH BLVD
DANIA BEACH FL
33004-3040
US

IV. Provider business mailing address

3553 W TREE TOPS CT
DAVIE FL
33328-7102
US

V. Phone/Fax

Practice location:
  • Phone: 954-920-7660
  • Fax: 954-920-7011
Mailing address:
  • Phone: 954-888-1383
  • Fax: 954-920-7011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS36058
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: