Provider Demographics
NPI:1972880540
Name:DIAZ, DELLIN (PHARM D)
Entity Type:Individual
Prefix:MRS
First Name:DELLIN
Middle Name:
Last Name:DIAZ
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13910 SW 39TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-6421
Mailing Address - Country:US
Mailing Address - Phone:305-807-7828
Mailing Address - Fax:
Practice Address - Street 1:5731 SW 40TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-5301
Practice Address - Country:US
Practice Address - Phone:305-666-0757
Practice Address - Fax:305-666-5445
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL45236183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist