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General NPI Number Information
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NPI Number | 1871205880
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Entity Type | Individual
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Provider Name | NETHANIA THELEMAQUE
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Gender | Female
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Dates
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Enumeration Date | 12/21/2022
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Last Update Date | 12/21/2022
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Provider Practice Location Address
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Address Line | 11501 N MILITARY TRL
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-6507
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Country | US
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Telephone | 561-805-2253
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Fax |
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Provider Business Mailing Address
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Address Line | 6675 RAINWOOD COVE LN
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City | LAKE WORTH
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State | FL
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Zip | 33463-7449
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Country | US
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Telephone | 561-932-7230
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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 | 62396
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License Number State | FL
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