Provider Demographics
NPI:1447311022
Name:NOVA SOUTHEASTERN UNIVERSITY CLINIC PHARMACY
Entity type:Organization
Organization Name:NOVA SOUTHEASTERN UNIVERSITY CLINIC PHARMACY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DEAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRES
Authorized Official - Middle Name:
Authorized Official - Last Name:MALAVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-262-1304
Mailing Address - Street 1:3200 S UNIVERSITY DR
Mailing Address - Street 2:NSU - COLLEGE OF PHARMACY
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-2018
Mailing Address - Country:US
Mailing Address - Phone:954-262-1304
Mailing Address - Fax:
Practice Address - Street 1:3200 S UNIVERSITY DR
Practice Address - Street 2:NSU - COLLEGE OF PHARMACY
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-2018
Practice Address - Country:US
Practice Address - Phone:954-262-1304
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPH0015775333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy