=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508583055
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PHILIP DUY DINH PHARM D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/25/2022
-----------------------------------------------------
Last Update Date | 10/25/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7458 UNIVERSAL BLVD
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32819-9210
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 260-425-0324
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7458 UNIVERSAL BLVD UNIT 4120
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32819-9262
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 260-425-0324
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PS65044
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------