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General NPI Number Information
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NPI Number | 1811179021
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Entity Type | Organization
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Legal Business Name | GREY DOG II INC
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Dates
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Enumeration Date | 11/29/2007
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Last Update Date | 11/04/2016
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Provider Practice Location Address
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Address Line | 6200 SUNSET DR STE 102
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-4828
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Country | US
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Telephone | 305-666-1605
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Fax | 305-666-1688
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Provider Business Mailing Address
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Address Line | 6200 SUNSET DR STE 102
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-4828
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Country | US
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Telephone | 305-666-1605
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Fax | 305-666-1688
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Authorized Official
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Title or Position | OWNER/PIC
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Name | ALI SEFFAR
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Credential | RPH
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Telephone | 305-666-1648
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | PH23091
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License Number State | FL
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