Provider Demographics
NPI:1790052363
Name:GIVENS, DEATRICK LEATRICE (RPH)
Entity Type:Individual
Prefix:
First Name:DEATRICK
Middle Name:LEATRICE
Last Name:GIVENS
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 1:14901 NE 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33161-2238
Mailing Address - Country:US
Mailing Address - Phone:305-949-5685
Mailing Address - Fax:
Practice Address - Street 1:14901 NE 6TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33161-2238
Practice Address - Country:US
Practice Address - Phone:305-949-5685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-25
Last Update Date:2011-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL26793183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist