=====================================================
General NPI Number Information
=====================================================
NPI Number | 1588264568
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PHILIP JAY ALSTEN RPH.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/28/2020
-----------------------------------------------------
Last Update Date | 10/28/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 411 S FEDERAL HWY STE D
-----------------------------------------------------
City | DEERFIELD BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33441-4170
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-531-0211
-----------------------------------------------------
Fax | 954-531-0241
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3000 NE 34TH ST
-----------------------------------------------------
City | LIGHTHOUSE POINT
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33064-8558
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-801-2896
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1835P2201X
-----------------------------------------------------
Taxonomy Name | Ambulatory Care Pharmacist
-----------------------------------------------------
License Number | PS19628
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------