Healthcare Provider Details

I. General information

NPI: 1912675356
Provider Name (Legal Business Name): SHENEKA LATONYA EXUMA PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 09/01/2021
Certification Date: 09/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14501 MIRAMAR PKWY
MIRAMAR FL
33027-4157
US

IV. Provider business mailing address

16339 SW 26TH ST
MIRAMAR FL
33027-4410
US

V. Phone/Fax

Practice location:
  • Phone: 954-885-1861
  • Fax:
Mailing address:
  • Phone: 954-348-3435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPS63101
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: