Healthcare Provider Details

I. General information

NPI: 1497437651
Provider Name (Legal Business Name): DYLAN ZEIDAN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2023
Last Update Date: 08/07/2023
Certification Date: 08/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 PLAZA BLVD
ST AUGUSTINE FL
32086-9304
US

IV. Provider business mailing address

250 PLAZA BLVD
ST AUGUSTINE FL
32086-9304
US

V. Phone/Fax

Practice location:
  • Phone: 904-808-9923
  • Fax:
Mailing address:
  • Phone: 904-808-9923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPS66076
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: