Provider Demographics
NPI:1548545429
Name:HERRERA, DALGIS (RPH)
Entity type:Individual
Prefix:
First Name:DALGIS
Middle Name:
Last Name:HERRERA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9123 NW 171ST LN
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-6650
Mailing Address - Country:US
Mailing Address - Phone:786-208-6035
Mailing Address - Fax:305-819-1013
Practice Address - Street 1:500B W 49TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33012-3605
Practice Address - Country:US
Practice Address - Phone:305-557-5468
Practice Address - Fax:305-557-8542
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS47442183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist