Provider Demographics
NPI:1235730979
Name:VIVES, MEHI GISELLE (RPH)
Entity Type:Individual
Prefix:
First Name:MEHI
Middle Name:GISELLE
Last Name:VIVES
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 S FLAMINGO RD
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33330-2300
Mailing Address - Country:US
Mailing Address - Phone:954-680-7821
Mailing Address - Fax:
Practice Address - Street 1:4700 S FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33330-2300
Practice Address - Country:US
Practice Address - Phone:954-680-7821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-07
Last Update Date:2020-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS49679183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist