=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962970442
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | YESENIA ANDREA SANIN PHARMD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/02/2018
-----------------------------------------------------
Last Update Date | 11/02/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1776 BISCAYNE BLVD
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33132-1129
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-358-3433
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 817 E VILLAGE CIR
-----------------------------------------------------
City | DAVIE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33325-4429
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 786-369-9785
-----------------------------------------------------
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 | PS58604
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------