Provider Demographics
NPI:1942965884
Name:MUNOZ DISCUA, DACIA MICHELLE
Entity Type:Individual
Prefix:
First Name:DACIA
Middle Name:MICHELLE
Last Name:MUNOZ DISCUA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4584 MARKS WAY
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-4467
Mailing Address - Country:US
Mailing Address - Phone:561-574-7936
Mailing Address - Fax:
Practice Address - Street 1:9855 LAKE WORTH RD
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-2305
Practice Address - Country:US
Practice Address - Phone:561-966-3330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-05
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL63486183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist