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General NPI Number Information
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NPI Number | 1104784420
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Entity Type | Individual
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Provider Name | OLESIA KOROTICH
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Gender | Female
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Dates
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Enumeration Date | 01/14/2026
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Last Update Date | 01/14/2026
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Provider Practice Location Address
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Address Line | 1150 N 35TH AVE STE 105
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City | HOLLYWOOD
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State | FL
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Zip | 33021-5424
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Country | US
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Telephone | 954-265-1299
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Fax |
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Provider Business Mailing Address
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Address Line | 14681 BISCAYNE BLVD UNIT 175
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City | NORTH MIAMI
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State | FL
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Zip | 33181-1211
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Country | US
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Telephone | 608-658-6873
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | PS68537
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License Number State | FL
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