Provider Demographics
NPI:1942598974
Name:HAMID DINO MOHEBBI
Entity Type:Organization
Organization Name:HAMID DINO MOHEBBI
Other - Org Name:MELROSE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:DINO
Authorized Official - Middle Name:
Authorized Official - Last Name:MOHEBBI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-576-1706
Mailing Address - Street 1:169 NW 36TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33127-3107
Mailing Address - Country:US
Mailing Address - Phone:305-576-1706
Mailing Address - Fax:
Practice Address - Street 1:169 NW 36TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33127-3107
Practice Address - Country:US
Practice Address - Phone:305-576-1706
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-11
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336S0011X
FLPH255723336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5706734OtherNCPDP PROVIDER IDENTIFICATION NUMBER