Provider Demographics
NPI:1568016707
Name:DEDAJ, NREC NICK (PHARMD)
Entity Type:Individual
Prefix:
First Name:NREC
Middle Name:NICK
Last Name:DEDAJ
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 1:31 PARKVIEW HEIGHTS BLVD
Mailing Address - Street 2:
Mailing Address - City:DEBARY
Mailing Address - State:FL
Mailing Address - Zip Code:32713-3735
Mailing Address - Country:US
Mailing Address - Phone:407-591-0992
Mailing Address - Fax:
Practice Address - Street 1:951 N STATE ROAD 434
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-7026
Practice Address - Country:US
Practice Address - Phone:407-682-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS59505183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist