Provider Demographics
NPI:1316650351
Name:DIMIS, ANTONIOS (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ANTONIOS
Middle Name:
Last Name:DIMIS
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 1:3348 FRANCOA DR
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-4456
Mailing Address - Country:US
Mailing Address - Phone:727-505-5099
Mailing Address - Fax:
Practice Address - Street 1:13589 SR 54
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-3527
Practice Address - Country:US
Practice Address - Phone:813-345-3917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-04
Last Update Date:2023-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS65236183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS65236OtherFL - DEPARTMENT OF HEALTH