Healthcare Provider Details

I. General information

NPI: 1699081158
Provider Name (Legal Business Name): DEXTER GIRVAN PEART PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2010
Last Update Date: 08/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 NW 16 ST
MIAMI FL
33125
US

IV. Provider business mailing address

13802 NORTH GARDEN COVE CIRCLE
DAVIE FL
33325-6707
US

V. Phone/Fax

Practice location:
  • Phone: 305-575-3102
  • Fax:
Mailing address:
  • Phone: 954-236-5585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS40463
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: