Healthcare Provider Details

I. General information

NPI: 1366788671
Provider Name (Legal Business Name): EMILY EDYTHE MARTUSCELLI PHARMD, BCPS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/14/2012
Last Update Date: 12/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 WASHINGTON ST
HOLLYWOOD FL
33021-8216
US

IV. Provider business mailing address

16221 SW 36TH ST
MIRAMAR FL
33027-4520
US

V. Phone/Fax

Practice location:
  • Phone: 954-518-5679
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS 37796
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPS 37796
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPS 37796
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: