Healthcare Provider Details

I. General information

NPI: 1659868982
Provider Name (Legal Business Name): JAMES MEZHERITSKIY PHARM.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2018
Last Update Date: 04/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1278 TIPPERARY DR
MELBOURNE FL
32940-6028
US

IV. Provider business mailing address

1278 TIPPERARY DR
MELBOURNE FL
32940-6028
US

V. Phone/Fax

Practice location:
  • Phone: 646-701-1564
  • Fax:
Mailing address:
  • Phone: 164-670-1156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS57355
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: