Provider Demographics
NPI:1346342979
Name:SOUMOFF, DENNIS (RPH)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:
Last Name:SOUMOFF
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10921 NW 12TH PL
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-6930
Mailing Address - Country:US
Mailing Address - Phone:954-423-9660
Mailing Address - Fax:954-423-8906
Practice Address - Street 1:680 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-4687
Practice Address - Country:US
Practice Address - Phone:954-764-2425
Practice Address - Fax:954-764-2421
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS00012195183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0556050968Medicare ID - Type UnspecifiedMEDICARE ID NUMBER