Healthcare Provider Details

I. General information

NPI: 1093234601
Provider Name (Legal Business Name): TIMOTHY DAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2017
Last Update Date: 09/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11750 SE FEDERAL HWY
HOBE SOUND FL
33455-5303
US

IV. Provider business mailing address

9125 SE MYSTIC COVE TER
HOBE SOUND FL
33455-7738
US

V. Phone/Fax

Practice location:
  • Phone: 772-545-5666
  • Fax:
Mailing address:
  • Phone: 203-530-8145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS57015
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: