Healthcare Provider Details

I. General information

NPI: 1184738809
Provider Name (Legal Business Name): RENEE MASHELL MOMON-UGWU PHARMD, BCNSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RENEE MASHELL MOMON PHARMD

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 NW 16TH ST
MIAMI FL
33125-1624
US

IV. Provider business mailing address

19051 NW 78TH PL
HIALEAH FL
33015-2758
US

V. Phone/Fax

Practice location:
  • Phone: 305-575-7000
  • Fax: 305-575-3386
Mailing address:
  • Phone: 305-829-8219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number16149
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code1835N1003X
TaxonomyNutrition Support Pharmacist
License NumberPS25295
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: