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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