Provider Demographics
NPI:1194744979
Name:GESSA, MEDYN M
Entity type:Individual
Prefix:MRS
First Name:MEDYN
Middle Name:M
Last Name:GESSA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13221 SW 50TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-5203
Mailing Address - Country:US
Mailing Address - Phone:305-262-5643
Mailing Address - Fax:305-262-5644
Practice Address - Street 1:7264 SW 8 ST.
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144
Practice Address - Country:US
Practice Address - Phone:305-262-5643
Practice Address - Fax:305-262-5644
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2022-07-18
Deactivation Date:2006-08-16
Deactivation Code:
Reactivation Date:2022-07-18
Provider Licenses
StateLicense IDTaxonomies
FLPH220603336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy