Provider Demographics
NPI:1962771451
Name:SEGURA, MAYA NENITA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MAYA
Middle Name:NENITA
Last Name:SEGURA
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 1:1070 CHASE HAMMOCK RD
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-7703
Mailing Address - Country:US
Mailing Address - Phone:321-626-7370
Mailing Address - Fax:321-453-7764
Practice Address - Street 1:2900 VETERANS WAY
Practice Address - Street 2:
Practice Address - City:VIERA
Practice Address - State:FL
Practice Address - Zip Code:32940-8007
Practice Address - Country:US
Practice Address - Phone:321-637-3788
Practice Address - Fax:321-637-3684
Is Sole Proprietor?:No
Enumeration Date:2011-12-29
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS44933183500000X
FLPU6659183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist