Provider Demographics
NPI:1902906134
Name:MAGNAVITA, MICHELLE GERARD (PHARMD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:GERARD
Last Name:MAGNAVITA
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 1:2900 N COMMERCE PARKWAY
Mailing Address - Street 2:ADDRESS LINE 2
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025
Mailing Address - Country:US
Mailing Address - Phone:888-849-7865
Mailing Address - Fax:
Practice Address - Street 1:2900 N COMMERCE PKWY
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-3959
Practice Address - Country:US
Practice Address - Phone:888-849-7865
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS27612183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist