Healthcare Provider Details

I. General information

NPI: 1972936847
Provider Name (Legal Business Name): ALEXANDER ZAGVAZDIN PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2013
Last Update Date: 08/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2104 W OAKLAND PARK BLVD
OAKLAND PARK FL
33311-1524
US

IV. Provider business mailing address

2104 W OAKLAND PARK BLVD
OAKLAND PARK FL
33311-1524
US

V. Phone/Fax

Practice location:
  • Phone: 954-486-7772
  • Fax: 954-486-0232
Mailing address:
  • Phone: 954-486-7772
  • Fax: 954-486-0232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS50985
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: