Provider Demographics
NPI:1437434396
Name:ETWARU, CHERENA
Entity Type:Individual
Prefix:
First Name:CHERENA
Middle Name:
Last Name:ETWARU
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 1:1100 CRYSTAL LAKE DR
Mailing Address - Street 2:APT 109
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064-1961
Mailing Address - Country:US
Mailing Address - Phone:954-288-5592
Mailing Address - Fax:
Practice Address - Street 1:3573 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064-6607
Practice Address - Country:US
Practice Address - Phone:954-941-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-11
Last Update Date:2011-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS35357183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist