Provider Demographics
NPI:1295286011
Name:DYNAMIC WELLNES, INC.
Entity type:Organization
Organization Name:DYNAMIC WELLNES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:GISELE
Authorized Official - Middle Name:
Authorized Official - Last Name:VELAZQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RPH, CPH
Authorized Official - Phone:305-815-0437
Mailing Address - Street 1:12150 SW 128TH CT
Mailing Address - Street 2:SUITE 217
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33186-4647
Mailing Address - Country:US
Mailing Address - Phone:786-732-2595
Mailing Address - Fax:786-732-2595
Practice Address - Street 1:12150 SW 128TH CT
Practice Address - Street 2:SUITE 217
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-4647
Practice Address - Country:US
Practice Address - Phone:786-732-2595
Practice Address - Fax:786-732-2595
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-17
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS37377183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty