MEDICARE: IMUENTINYAN SARIRATU SALAMI

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS33069	FL

General Provider Information

NPI Number	:	1093301707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IMUENTINYAN SARIRATU SALAMI

Provider Business Mailing Address
First Line	:	15772 SW 24TH ST
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33027-4266
Country	:	US
Telephone Number	:	954-253-4018
Fax Number	:

Provider Business Practice Location Address
First Line	:	3135 GRAND AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33133-5103
Country	:	US
Telephone Number	:	305-445-7533
Fax Number	:	786-899-0686

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/16/2020
Last Update Date	:	12/16/2020

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