Healthcare Provider Details

I. General information

NPI: 1568383263
Provider Name (Legal Business Name): BEACHSIDE MEDICAL AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

576 NW 3RD ST
FLORIDA CITY FL
33034-3206
US

IV. Provider business mailing address

576 NW 3RD ST
FLORIDA CITY FL
33034-3206
US

V. Phone/Fax

Practice location:
  • Phone: 661-376-7393
  • Fax:
Mailing address:
  • Phone: 661-376-7393
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: SANTOYA MITCHELL-DUNN
Title or Position: MANAGER
Credential:
Phone: 661-376-7393