Provider Demographics
NPI:1265032650
Name:MIZELL, DEAHLO MIZELL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DEAHLO MIZELL
Middle Name:
Last Name:MIZELL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1755 42ND SQ APT 101
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-0571
Mailing Address - Country:US
Mailing Address - Phone:954-670-3638
Mailing Address - Fax:
Practice Address - Street 1:1750 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5545
Practice Address - Country:US
Practice Address - Phone:772-410-2642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS57127183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist