MEDICARE: LAQUINTA W HYPPOLITE

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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	PS 35252	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275585721
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAQUINTA W HYPPOLITE

Provider Business Mailing Address
First Line	:	4305 SW 179TH WAY
Second Line	:
City	:	MIRAMAR
State	:	FL
Zip	:	33029-6303
Country	:	US
Telephone Number	:	954-812-3843
Fax Number	:	954-362-4739

Provider Business Practice Location Address
First Line	:	9021 TAFT ST
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33024-4676
Country	:	US
Telephone Number	:	954-362-4738
Fax Number	:	954-362-4739

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

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	10/08/2014

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Directions to “ LAQUINTA W HYPPOLITE ” Practice Location

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