MEDICARE: DR. LATRICE ROEBUCK PHARM.D

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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	PS41695	FL
2	1835P1200X	Pharmacotherapy Pharmacist	PS41695	FL

General Provider Information

NPI Number	:	1841425923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LATRICE ROEBUCK PHARM.D

Provider Business Mailing Address
First Line	:	2640 HOLLYWOOD BLVD
Second Line	:	SUITE 209
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-4852
Country	:	US
Telephone Number	:	786-210-0861
Fax Number	:

Provider Business Practice Location Address
First Line	:	2640 HOLLYWOOD BLVD
Second Line	:	SUITE 209
City	:	HOLLYWOOD
State	:	FL
Zip	:	33020-4852
Country	:	US
Telephone Number	:	954-367-3843
Fax Number	:	954-589-0083

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

Provider Enumeration Date	:	05/19/2009
Last Update Date	:	07/15/2012

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