Provider Demographics
NPI:1659589943
Name:MEDEROS, DAILIS
Entity Type:Individual
Prefix:
First Name:DAILIS
Middle Name:
Last Name:MEDEROS
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 1:1481 W 41ST ST APT 316
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33012-5942
Mailing Address - Country:US
Mailing Address - Phone:305-801-9923
Mailing Address - Fax:
Practice Address - Street 1:5945 W 25TH CT
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-4423
Practice Address - Country:US
Practice Address - Phone:305-558-7800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL320101050756233183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician