Healthcare Provider Details

I. General information

NPI: 1144229790
Provider Name (Legal Business Name): JAMAL KALEEM WEDDERBURN PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/16/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12349 SW 53RD ST SUITE 205
COOPER CITY FL
33330-3338
US

IV. Provider business mailing address

9324 SW 220TH ST
MIAMI FL
33190-1110
US

V. Phone/Fax

Practice location:
  • Phone: 954-252-5556
  • Fax: 954-680-1347
Mailing address:
  • Phone: 305-233-3957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS36096
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: