Healthcare Provider Details

I. General information

NPI: 1093301707
Provider Name (Legal Business Name): IMUENTINYAN SARIRATU SALAMI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2020
Last Update Date: 12/16/2020
Certification Date: 12/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3135 GRAND AVE
MIAMI FL
33133-5103
US

IV. Provider business mailing address

15772 SW 24TH ST
MIRAMAR FL
33027-4266
US

V. Phone/Fax

Practice location:
  • Phone: 305-445-7533
  • Fax: 786-899-0686
Mailing address:
  • Phone: 954-253-4018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS33069
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: