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General NPI Number Information
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NPI Number | 1518211010
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Entity Type | Individual
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Provider Name | LAURA PEQUENO PHARM D.
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Gender | Female
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Dates
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Enumeration Date | 11/05/2012
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Last Update Date | 11/05/2012
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Provider Practice Location Address
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Address Line | 1901 SW 172ND AVE
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City | MIRAMAR
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State | FL
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Zip | 33029-5592
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Country | US
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Telephone | 954-538-4783
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Fax |
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Provider Business Mailing Address
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Address Line | 7357 NW 114TH TER
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City | PARKLAND
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State | FL
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Zip | 33076-4243
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Country | US
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Telephone |
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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 | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | PS33598
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License Number State | FL
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