Provider Demographics
NPI:1689879090
Name:SUBONI, DOREL (PHARMD)
Entity Type:Individual
Prefix:
First Name:DOREL
Middle Name:
Last Name:SUBONI
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 1:3553 W TREE TOPS CT
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-7102
Mailing Address - Country:US
Mailing Address - Phone:954-888-1383
Mailing Address - Fax:954-920-7011
Practice Address - Street 1:402 E DANIA BEACH BLVD
Practice Address - Street 2:
Practice Address - City:DANIA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33004-3040
Practice Address - Country:US
Practice Address - Phone:954-920-7660
Practice Address - Fax:954-920-7011
Is Sole Proprietor?:No
Enumeration Date:2007-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS36058183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist