Organization
DYALS MASON AVENUE PHARMACY INC
Active
Organization
DYALS MASON AVENUE PHARMACY INC
Active
Other names
STEVES PHARMACY
Organization subpart
No
Provider details
NPI number
Authorized official
FRANK FRANCIS (CONSULTANT)
(386) 299-1231
Entity
Organization
Contact information
Practice address
636 MASON AVE, DAYTONA BEACH, FL 32117-4835
(386) 255-0907
(386) 253-5541
Mailing address
636 MASON AVE, DAYTONA BEACH, FL 32117-4835
(386) 255-0907
(386) 253-5541
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PH2635
FL
3336C0004X
Compounding Pharmacy
—
—
3336L0003X
Long Term Care Pharmacy
—
—
3336S0011X
Specialty Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104754000
—
FL
01
—
2004058
PK
—
Enumeration date
03/08/2007
Last updated
02/20/2017
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