Provider Demographics
NPI:1598066607
Name:HALLMON, NASIYA DENISE
Entity Type:Individual
Prefix:
First Name:NASIYA
Middle Name:DENISE
Last Name:HALLMON
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 1:4754 NW 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33127-2256
Mailing Address - Country:US
Mailing Address - Phone:305-951-7497
Mailing Address - Fax:
Practice Address - Street 1:4754 NW 11TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33127-2256
Practice Address - Country:US
Practice Address - Phone:305-951-7497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-04
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPSI 25335183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist