Healthcare Provider Details

I. General information

NPI: 1699956060
Provider Name (Legal Business Name): MARLENE LLOSENT PHARM.D., BCPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2007
Last Update Date: 11/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1695 NW 9TH AVE MENTAL HEALTH PHARMACY SUITE # 1311
MIAMI FL
33136-1409
US

IV. Provider business mailing address

1695 NW 9TH AVE MENTAL HEALTH PHARMACY SUITE # 1311
MIAMI FL
33136-1409
US

V. Phone/Fax

Practice location:
  • Phone: 305-355-7208
  • Fax: 305-355-7196
Mailing address:
  • Phone: 305-355-7208
  • Fax: 305-355-7196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License NumberPS 22185
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: