Provider Demographics
NPI:1093301707
Name:SALAMI, IMUENTINYAN SARIRATU
Entity Type:Individual
Prefix:
First Name:IMUENTINYAN
Middle Name:SARIRATU
Last Name:SALAMI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15772 SW 24TH ST
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027-4266
Mailing Address - Country:US
Mailing Address - Phone:954-253-4018
Mailing Address - Fax:
Practice Address - Street 1:3135 GRAND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-5103
Practice Address - Country:US
Practice Address - Phone:305-445-7533
Practice Address - Fax:786-899-0686
Is Sole Proprietor?:No
Enumeration Date:2020-12-16
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS33069183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist