Healthcare Provider Details

I. General information

NPI: 1316074750
Provider Name (Legal Business Name): DEYSI PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7176 SW 47TH ST
MIAMI FL
33155-4655
US

IV. Provider business mailing address

7176 SW 47TH ST
MIAMI FL
33155-4655
US

V. Phone/Fax

Practice location:
  • Phone: 305-668-9354
  • Fax: 305-668-9354
Mailing address:
  • Phone: 305-668-9354
  • Fax: 305-668-9354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DEISY HERNANDE
Title or Position: PRESIDENT
Credential:
Phone: 305-668-9354