Provider Demographics
NPI:1962126680
Name:ALEXIS, MARK (PHARMD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:ALEXIS
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 1:13749 SW 152ND ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33177-8125
Mailing Address - Country:US
Mailing Address - Phone:305-255-2893
Mailing Address - Fax:
Practice Address - Street 1:13749 SW 152ND ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33177-8125
Practice Address - Country:US
Practice Address - Phone:305-255-2893
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS59302183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist