Provider Demographics
NPI:1407053721
Name:SLACK, TAMIKA CREWS (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:TAMIKA
Middle Name:CREWS
Last Name:SLACK
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10980 MERIDIAN DR S
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-4609
Mailing Address - Country:US
Mailing Address - Phone:407-590-5120
Mailing Address - Fax:
Practice Address - Street 1:9990 BELVEDERE RD
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-3518
Practice Address - Country:US
Practice Address - Phone:561-795-0135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS34171183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist