Provider Demographics
NPI:1689920589
Name:MONDESIR, HIMLER (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:HIMLER
Middle Name:
Last Name:MONDESIR
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 1:436 CIRCLE DR S
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-2534
Mailing Address - Country:US
Mailing Address - Phone:561-542-2499
Mailing Address - Fax:
Practice Address - Street 1:10201 HAGEN RANCH RD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3758
Practice Address - Country:US
Practice Address - Phone:561-536-0262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-28
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS49271183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist