Provider Demographics
NPI:1710074398
Name:AVERHOFF, NILSA R (RPH)
Entity Type:Individual
Prefix:MS
First Name:NILSA
Middle Name:R
Last Name:AVERHOFF
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14343 SW 90TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-8008
Mailing Address - Country:US
Mailing Address - Phone:305-385-4448
Mailing Address - Fax:305-596-3132
Practice Address - Street 1:14343 SW 90TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-8008
Practice Address - Country:US
Practice Address - Phone:305-385-4448
Practice Address - Fax:305-596-3132
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL21848183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist