Provider Demographics
NPI:1003192071
Name:MOORE, LA'QUESHA TEQUILA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LA'QUESHA
Middle Name:TEQUILA
Last Name:MOORE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18300 NW 37TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33056-5101
Mailing Address - Country:US
Mailing Address - Phone:305-626-9469
Mailing Address - Fax:305-626-9329
Practice Address - Street 1:18300 NW 37TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33056-5101
Practice Address - Country:US
Practice Address - Phone:305-626-9469
Practice Address - Fax:305-626-9329
Is Sole Proprietor?:No
Enumeration Date:2011-10-22
Last Update Date:2011-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS45843183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist