Provider Demographics
NPI:1508377664
Name:HERMIDA, GISSEL (PHARMD)
Entity Type:Individual
Prefix:
First Name:GISSEL
Middle Name:
Last Name:HERMIDA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5851 SUMMERLAKE DR APT 304
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-3650
Mailing Address - Country:US
Mailing Address - Phone:954-338-0057
Mailing Address - Fax:
Practice Address - Street 1:5851 SUMMERLAKE DR APT 304
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-3650
Practice Address - Country:US
Practice Address - Phone:954-338-0057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-17
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS57233183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist