Provider Demographics
NPI:1750898508
Name:DIAS, DANIELE VASCONCELOS (PHARMD)
Entity type:Individual
Prefix:
First Name:DANIELE
Middle Name:VASCONCELOS
Last Name:DIAS
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 1:9121 N MILITARY TRL STE 106
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-5985
Mailing Address - Country:US
Mailing Address - Phone:561-847-4820
Mailing Address - Fax:561-847-4823
Practice Address - Street 1:9121 N MILITARY TRL STE 106
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-5985
Practice Address - Country:US
Practice Address - Phone:561-847-4820
Practice Address - Fax:561-847-4823
Is Sole Proprietor?:No
Enumeration Date:2018-01-02
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS45646183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist