Provider Demographics
NPI:1356774699
Name:BERNSTEIN, ALICIA KAY
Entity type:Individual
Prefix:DR
First Name:ALICIA
Middle Name:KAY
Last Name:BERNSTEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3333 NE 34TH ST
Mailing Address - Street 2:UNIT 1317
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-6948
Mailing Address - Country:US
Mailing Address - Phone:954-993-6376
Mailing Address - Fax:
Practice Address - Street 1:3333 NE 34TH ST
Practice Address - Street 2:UNIT 1317
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-6948
Practice Address - Country:US
Practice Address - Phone:954-993-6376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-09
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS50965183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist