Individual
AU DIEU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
5405 49TH ST N, ST PETERSBURG, FL 33709-2101
(727) 527-8285
(727) 527-8345
Mailing address
5781 80TH AVE N, PINELLAS PARK, FL 33781-2224
(727) 501-5765
(727) 527-8345
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
PS45105
FL
Other
Enumeration date
11/29/2020
Last updated
11/29/2020
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