Healthcare Provider Details

I. General information

NPI: 1548177553
Provider Name (Legal Business Name): GENNICA NEREUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13628 W STATE ROAD 84
DAVIE FL
33325-5301
US

IV. Provider business mailing address

2345 NW 34TH ST
MIAMI FL
33142-5307
US

V. Phone/Fax

Practice location:
  • Phone: 954-474-7123
  • Fax:
Mailing address:
  • Phone: 954-474-7123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS71398
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: