MEDICARE: CLETUS M MADUKA PHARM.D

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	PS24941	FL

General Provider Information

NPI Number	:	1811629934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLETUS M MADUKA PHARM.D

Provider Business Mailing Address
First Line	:	PO BOX 823821
Second Line	:
City	:	PEMBROKE PINES
State	:	FL
Zip	:	33082-3821
Country	:	US
Telephone Number	:	305-216-4545
Fax Number	:

Provider Business Practice Location Address
First Line	:	3085 W 80TH ST
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33018-3888
Country	:	US
Telephone Number	:	305-863-4277
Fax Number	:	305-735-7484

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

Provider Enumeration Date	:	06/28/2022
Last Update Date	:	07/08/2022

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