Provider Demographics
NPI:1790187821
Name:MEAD, DYLAN (PHARMD)
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:
Last Name:MEAD
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 1:9440 POINCIANA PL
Mailing Address - Street 2:APT 116
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-4861
Mailing Address - Country:US
Mailing Address - Phone:646-369-6298
Mailing Address - Fax:
Practice Address - Street 1:10065 CLEARY BLVD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1063
Practice Address - Country:US
Practice Address - Phone:954-473-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-19
Last Update Date:2014-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS52269183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist