Healthcare Provider Details

I. General information

NPI: 1235898925
Provider Name (Legal Business Name): RAPHAELA ALICE NISENZONE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2021
Last Update Date: 12/10/2021
Certification Date: 12/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E SAMPLE RD
DEERFIELD BEACH FL
33064-3502
US

IV. Provider business mailing address

1830 S OCEAN DR APT 3710
HALLANDALE BEACH FL
33009-7714
US

V. Phone/Fax

Practice location:
  • Phone: 954-941-8300
  • Fax:
Mailing address:
  • Phone: 917-848-5557
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS62576
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: