Basic Information
| Provider Information | |||||||||
| NPI: | 1528345279 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WELLENS MCINTOSH | ||||||||
| FirstName: | DAWN | ||||||||
| MiddleName: | |||||||||
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| Credential: | PHARMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3705 HOLLYWOOD BLVD | ||||||||
| Address2: | |||||||||
| City: | HOLLYWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330216810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9549624787 | ||||||||
| FaxNumber: | 9549624782 | ||||||||
| Practice Location | |||||||||
| Address1: | 3705 HOLLYWOOD BLVD | ||||||||
| Address2: | |||||||||
| City: | HOLLYWOOD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330216810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9549624787 | ||||||||
| FaxNumber: | 9549624782 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2011 | ||||||||
| LastUpdateDate: | 11/09/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | PS32818 | FL | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.