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General NPI Number Information
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NPI Number | 1568016707
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Entity Type | Individual
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Provider Name | NREC NICK DEDAJ PHARMD
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Gender | Male
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Dates
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Enumeration Date | 07/25/2019
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Last Update Date | 07/25/2019
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Provider Practice Location Address
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Address Line | 951 N STATE ROAD 434
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City | ALTAMONTE SPRINGS
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State | FL
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Zip | 32714-7026
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Country | US
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Telephone | 407-682-4100
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Fax |
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Provider Business Mailing Address
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Address Line | 31 PARKVIEW HEIGHTS BLVD
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City | DEBARY
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State | FL
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Zip | 32713-3735
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Country | US
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Telephone | 407-591-0992
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS59505
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License Number State | FL
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