MEDICARE: MS. DENIQUE REDDIE PHARMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS51191	FL

General Provider Information

NPI Number	:	1285246314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DENIQUE REDDIE PHARMD

Provider Business Mailing Address
First Line	:	1213 PALM BAY RD
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32905-3781
Country	:	US
Telephone Number	:	321-676-4602
Fax Number	:	321-676-0536

Provider Business Practice Location Address
First Line	:	1213 PALM BAY RD
Second Line	:
City	:	MELBOURNE
State	:	FL
Zip	:	32905-3781
Country	:	US
Telephone Number	:	321-676-4602
Fax Number	:	321-676-0536

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/19/2020
Last Update Date	:	08/19/2020

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