Provider Demographics
NPI:1891449872
Name:DIVYO HEALTH SOLUTIONS INC
Entity Type:Organization
Organization Name:DIVYO HEALTH SOLUTIONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYFUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-675-5210
Mailing Address - Street 1:PO BOX 108
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30162-0108
Mailing Address - Country:US
Mailing Address - Phone:855-675-5210
Mailing Address - Fax:855-675-5212
Practice Address - Street 1:320 W 9TH ST NE
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-2726
Practice Address - Country:US
Practice Address - Phone:855-675-5210
Practice Address - Fax:855-675-5212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-08
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1174898464OtherDERMATRAN HEALTH SOLUTIONS