Healthcare Provider Details

I. General information

NPI: 1063316784
Provider Name (Legal Business Name): DIVERSE RX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8040 NW 95TH ST STE 228
HIALEAH GARDENS FL
33016-2361
US

IV. Provider business mailing address

8040 NW 95TH ST STE 228
HIALEAH GARDENS FL
33016-2361
US

V. Phone/Fax

Practice location:
  • Phone: 786-238-7656
  • Fax:
Mailing address:
  • Phone: 786-238-7656
  • Fax: 786-238-7725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LEYSI MERCEDES SANCHEZ
Title or Position: OFFICER/OWNER
Credential:
Phone: 786-238-7656