Healthcare Provider Details

I. General information

NPI: 1942598974
Provider Name (Legal Business Name): HAMID DINO MOHEBBI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2011
Last Update Date: 03/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 NW 36TH ST
MIAMI FL
33127-3107
US

IV. Provider business mailing address

169 NW 36TH ST
MIAMI FL
33127-3107
US

V. Phone/Fax

Practice location:
  • Phone: 305-576-1706
  • Fax:
Mailing address:
  • Phone: 305-576-1706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH25572
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DINO MOHEBBI
Title or Position: PHARMACIST
Credential:
Phone: 305-576-1706