Healthcare Provider Details

I. General information

NPI: 1427963131
Provider Name (Legal Business Name): JACQUALINE IGWE ETUMNU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14400 COMMERCE WAY
MIAMI LAKES FL
33016-1508
US

IV. Provider business mailing address

9709 W 34TH LN
HIALEAH GARDENS FL
33018-2019
US

V. Phone/Fax

Practice location:
  • Phone: 786-595-0382
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS56568
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: