Provider Demographics
NPI:1063125128
Name:METAYER, GIDNIE (PHARMD)
Entity type:Individual
Prefix:
First Name:GIDNIE
Middle Name:
Last Name:METAYER
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12425 HAGEN RANCH RD
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-4107
Mailing Address - Country:US
Mailing Address - Phone:561-292-4494
Mailing Address - Fax:561-292-4499
Practice Address - Street 1:12425 HAGEN RANCH RD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-4107
Practice Address - Country:US
Practice Address - Phone:561-292-4494
Practice Address - Fax:561-292-4499
Is Sole Proprietor?:No
Enumeration Date:2023-01-03
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS65302183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist