Provider Demographics
NPI:1417540634
Name:TREZZA, KAILA
Entity Type:Individual
Prefix:
First Name:KAILA
Middle Name:
Last Name:TREZZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9325 LAGOON PL APT 208
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-6734
Mailing Address - Country:US
Mailing Address - Phone:954-257-8920
Mailing Address - Fax:
Practice Address - Street 1:21950 S TAMIAMI TRL
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-3231
Practice Address - Country:US
Practice Address - Phone:239-948-3458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-18
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS61976183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist