Provider Demographics
NPI:1255936282
Name:THEOC, CASSIE ALDA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CASSIE
Middle Name:ALDA
Last Name:THEOC
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11930 SW 253RD TER
Mailing Address - Street 2:
Mailing Address - City:HOMESTEAD
Mailing Address - State:FL
Mailing Address - Zip Code:33032-6010
Mailing Address - Country:US
Mailing Address - Phone:305-343-8584
Mailing Address - Fax:
Practice Address - Street 1:11221 SW 152ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157-1101
Practice Address - Country:US
Practice Address - Phone:305-251-5033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS51942183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist