Provider Demographics
NPI:1396028163
Name:DALLAL, YEHIA
Entity Type:Individual
Prefix:DR
First Name:YEHIA
Middle Name:
Last Name:DALLAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21880 STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-2804
Mailing Address - Country:US
Mailing Address - Phone:561-470-0647
Mailing Address - Fax:561-470-5943
Practice Address - Street 1:21880 STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-2804
Practice Address - Country:US
Practice Address - Phone:561-470-0647
Practice Address - Fax:561-470-5943
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS28626183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist