Provider Demographics
NPI:1295004059
Name:FONTE, LERYCKA (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:LERYCKA
Middle Name:
Last Name:FONTE
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 1:18600 NW 87 AVE # 109
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33015-2918
Mailing Address - Country:US
Mailing Address - Phone:305-405-3333
Mailing Address - Fax:305-405-3334
Practice Address - Street 1:18600 NW 87 AVE # 109
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33015-2918
Practice Address - Country:US
Practice Address - Phone:305-405-3333
Practice Address - Fax:305-405-3334
Is Sole Proprietor?:No
Enumeration Date:2011-12-23
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS36832183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist