Provider Demographics
NPI:1164794335
Name:JOODA, JOHN ABIMBOLA (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:ABIMBOLA
Last Name:JOODA
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6715 NW 38 DRIVE
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33319
Mailing Address - Country:US
Mailing Address - Phone:954-297-0587
Mailing Address - Fax:954-766-4466
Practice Address - Street 1:1920 E 4TH AVE
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33010-2714
Practice Address - Country:US
Practice Address - Phone:305-805-9950
Practice Address - Fax:305-805-9949
Is Sole Proprietor?:No
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPSA418421835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPS 41842OtherLICENSE