Healthcare Provider Details

I. General information

NPI: 1639782576
Provider Name (Legal Business Name): NYASHA MACK HALL PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2020
Last Update Date: 08/29/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7031 WASHINGTON AVE
LANTANA FL
33462-5201
US

IV. Provider business mailing address

151 LAKE MONTEREY CIR
BOYNTON BEACH FL
33426-8436
US

V. Phone/Fax

Practice location:
  • Phone: 561-585-6911
  • Fax: 561-585-2610
Mailing address:
  • Phone: 305-484-6103
  • Fax: 561-585-2610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License NumberPS33824
License Number StateFL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierPS33824
Identifier TypeOTHER
Identifier StateFL
Identifier IssuerFLORIDA BOARD OF PHARMACY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: