Healthcare Provider Details

I. General information

NPI: 1639909898
Provider Name (Legal Business Name): ALEXANDER PUIG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2024
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10130 NORTHLAKE BLVD
WEST PALM BEACH FL
33412-1101
US

IV. Provider business mailing address

12251 80TH LN N
WEST PALM BEACH FL
33412-2299
US

V. Phone/Fax

Practice location:
  • Phone: 561-799-6808
  • Fax:
Mailing address:
  • Phone: 727-389-0026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number67374
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: