Healthcare Provider Details

I. General information

NPI: 1487196093
Provider Name (Legal Business Name): DEMETRIA GRIFFIN PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2016
Last Update Date: 11/18/2020
Certification Date: 11/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9600 PARKSOUTH CT STE 120
ORLANDO FL
32837-6424
US

IV. Provider business mailing address

6500 SAND LAKE SOUND RD UNIT 1408
ORLANDO FL
32819-7498
US

V. Phone/Fax

Practice location:
  • Phone: 877-453-4566
  • Fax: 866-537-0877
Mailing address:
  • Phone: 323-975-7817
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS50065
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: