Provider Demographics
NPI:1700395969
Name:FLORESTAL, DUDLEY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:DUDLEY
Middle Name:
Last Name:FLORESTAL
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 1:5036 SANCERRE CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-7452
Mailing Address - Country:US
Mailing Address - Phone:561-602-7342
Mailing Address - Fax:
Practice Address - Street 1:4943 LE CHALET BLVD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-1405
Practice Address - Country:US
Practice Address - Phone:561-602-7342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-20
Last Update Date:2017-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS57121183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist