Provider Demographics
NPI:1043660103
Name:MCINTOSH, DAVINA (PHARMD)
Entity Type:Individual
Prefix:
First Name:DAVINA
Middle Name:
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15951 SW 41ST ST
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33331-1535
Mailing Address - Country:US
Mailing Address - Phone:888-319-1818
Mailing Address - Fax:844-508-3366
Practice Address - Street 1:15951 SW 41ST ST
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33331-1535
Practice Address - Country:US
Practice Address - Phone:888-319-1818
Practice Address - Fax:844-508-3366
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS54344183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist