Provider Demographics
NPI:1386285807
Name:DIZ, MANUEL A (PHARMD)
Entity type:Individual
Prefix:
First Name:MANUEL
Middle Name:A
Last Name:DIZ
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 1:2360 SW ARCHER RD APT 1112
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-1050
Mailing Address - Country:US
Mailing Address - Phone:407-501-9437
Mailing Address - Fax:
Practice Address - Street 1:5171 NW 43RD ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-4456
Practice Address - Country:US
Practice Address - Phone:352-372-8786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-06
Last Update Date:2019-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS59979183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist