Healthcare Provider Details

I. General information

NPI: 1982987277
Provider Name (Legal Business Name): MRS. AMAKA AJULUCHUKWU
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2011
Last Update Date: 09/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6907 OKEECHOBEE BLVD.
WEST PALM BEACH FL
33411
US

IV. Provider business mailing address

6907 OKEECHOBEE BLVD
WEST PALM BEACH FL
33411-2509
US

V. Phone/Fax

Practice location:
  • Phone: 561-478-1154
  • Fax: 561-478-8405
Mailing address:
  • Phone: 561-478-1154
  • Fax: 561-478-8405

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPS31465
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: