Provider Demographics
NPI:1821615683
Name:MAKI, ALEXANDER
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:MAKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 NE 28TH CT APT 5
Mailing Address - Street 2:
Mailing Address - City:LIGHTHOUSE POINT
Mailing Address - State:FL
Mailing Address - Zip Code:33064-9307
Mailing Address - Country:US
Mailing Address - Phone:352-999-2937
Mailing Address - Fax:
Practice Address - Street 1:6270 W SAMPLE RD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33067-3176
Practice Address - Country:US
Practice Address - Phone:954-344-5565
Practice Address - Fax:954-344-5570
Is Sole Proprietor?:No
Enumeration Date:2020-06-28
Last Update Date:2020-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS60807183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS60807OtherSTATE OF FLORIDA DEPARTMENT OF HEALTH PHARMACIST LICENSE