Provider Demographics
NPI:1063991099
Name:NEKTALOW, MICHAEL DAVID (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DAVID
Last Name:NEKTALOW
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5025 MALLARDS PL
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-4510
Mailing Address - Country:US
Mailing Address - Phone:754-244-5262
Mailing Address - Fax:
Practice Address - Street 1:22100 STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-4218
Practice Address - Country:US
Practice Address - Phone:561-226-3158
Practice Address - Fax:561-226-3159
Is Sole Proprietor?:No
Enumeration Date:2018-08-10
Last Update Date:2023-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS57815183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist