Healthcare Provider Details

I. General information

NPI: 1992046437
Provider Name (Legal Business Name): MYMTM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2013
Last Update Date: 03/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 E. PARK AVENUE
TALLAHASSEE FL
32301
US

IV. Provider business mailing address

304 INDIAN TRACE #191
WESTON FL
33326
US

V. Phone/Fax

Practice location:
  • Phone: 954-261-8211
  • Fax: 954-333-3822
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number
License Number State

VIII. Authorized Official

Name: MS. DAWN D. DULIN-FELIX
Title or Position: PRESIDENT
Credential: RPH
Phone: 954-261-8211