Provider Demographics
NPI:1568882264
Name:JOSEPHS, DERYCK (RPH)
Entity Type:Individual
Prefix:MR
First Name:DERYCK
Middle Name:
Last Name:JOSEPHS
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 1:804 W BLOOMINGDALE AVE
Mailing Address - Street 2:SUITE 1-4
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-7778
Mailing Address - Country:US
Mailing Address - Phone:813-689-9489
Mailing Address - Fax:813-651-0284
Practice Address - Street 1:804 W BLOOMINGDALE AVE
Practice Address - Street 2:SUITE 1-4
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-7778
Practice Address - Country:US
Practice Address - Phone:813-689-9489
Practice Address - Fax:813-651-0284
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 26844183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS 26844OtherSTATE OF FLORIDA DOH