Provider Demographics
NPI:1053917385
Name:LAY, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:LAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15204 SW 12TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33194-2693
Mailing Address - Country:US
Mailing Address - Phone:786-306-3605
Mailing Address - Fax:
Practice Address - Street 1:13675 SW 88TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-1324
Practice Address - Country:US
Practice Address - Phone:305-385-1035
Practice Address - Fax:305-386-4321
Is Sole Proprietor?:No
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS43334183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist