Healthcare Provider Details

I. General information

NPI: 1891399523
Provider Name (Legal Business Name): SHANTELL YACHETTA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/23/2020
Last Update Date: 11/23/2020
Certification Date: 11/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 N FEDERAL HWY
FORT LAUDERDALE FL
33301-1113
US

IV. Provider business mailing address

502 NE 7TH AVE UNIT 2
FORT LAUDERDALE FL
33301-1210
US

V. Phone/Fax

Practice location:
  • Phone: 954-524-0500
  • Fax: 954-524-8092
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS57338
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: