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NPI Code Detail

MEDICARE: NETHANIA THELEMAQUE

MEDICARE: NETHANIA THELEMAQUE
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
1183500000XPharmacist62396FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
162396OTHERFLSTATE OF FLORIDA DEPARTMENT OF HEALTH DIVISION OF MEDICAL QUALITY ASSURANCE

General Provider Information

NPI Number : 1871205880
Entity Type Code : Individual
Provider Name (Legal Business Name) : NETHANIA THELEMAQUE
Provider Business Mailing Address
First Line : 6675 RAINWOOD COVE LN
Second Line :
City : LAKE WORTH
State : FL
Zip : 33463-7449
Country : US
Telephone Number : 561-932-7230
Fax Number :
Provider Business Practice Location Address
First Line : 11501 N MILITARY TRL
Second Line :
City : PALM BEACH GARDENS
State : FL
Zip : 33410-6507
Country : US
Telephone Number : 561-805-2253
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/21/2022
Last Update Date : 12/21/2022

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Directions to “ NETHANIA THELEMAQUE ” Practice Location

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