Healthcare Provider Details

I. General information

NPI: 1093099699
Provider Name (Legal Business Name): PHARMACEUTICAL CARE ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2011
Last Update Date: 10/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2640 HOLLYWOOD BLVD SUITE 209
HOLLYWOOD FL
33020-4852
US

IV. Provider business mailing address

2640 HOLLYWOOD BLVD SUITE 209
HOLLYWOOD FL
33020-4852
US

V. Phone/Fax

Practice location:
  • Phone: 954-367-3843
  • Fax:
Mailing address:
  • Phone: 954-367-3843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPS41695
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberPS41695
License Number StateFL

VIII. Authorized Official

Name: DR. LATRICE ROEBUCK
Title or Position: MANAGING MEMBER OF LLC/PHARMACIST
Credential: PHARM.D
Phone: 786-210-0861