Healthcare Provider Details

I. General information

NPI: 1184743189
Provider Name (Legal Business Name): DEANNA ROSE MINA PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 10/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5201 RAYMOND ST
ORLANDO FL
32803-8208
US

IV. Provider business mailing address

5201 RAYMOND ST
ORLANDO FL
32803-8208
US

V. Phone/Fax

Practice location:
  • Phone: 352-327-2424
  • Fax:
Mailing address:
  • Phone: 352-327-2424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number18196
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS41998
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPS41998
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: