MEDICARE: MYRIAM DORMERVIL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS56711	FL

General Provider Information

NPI Number	:	1588598346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MYRIAM DORMERVIL

Provider Business Mailing Address
First Line	:	1227 NW 87TH AVE
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-7176
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	261 N UNIVERSITY DR
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33324-2002
Country	:	US
Telephone Number	:	401-526-6863
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2026
Last Update Date	:	06/09/2026

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Directions to “ MYRIAM DORMERVIL ” Practice Location

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