Healthcare Provider Details

I. General information

NPI: 1740193085
Provider Name (Legal Business Name): SITA LACKNAUTH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NW 74TH TER
PLANTATION FL
33317-1037
US

IV. Provider business mailing address

600 NW 74TH TER
PLANTATION FL
33317-1037
US

V. Phone/Fax

Practice location:
  • Phone: 305-788-0904
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS35889
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: