Provider Demographics
NPI:1508400789
Name:SPENCER IGBOKWE, LATREVIA (PHARMD)
Entity Type:Individual
Prefix:
First Name:LATREVIA
Middle Name:
Last Name:SPENCER IGBOKWE
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 1:1912 ARDEN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-8476
Mailing Address - Country:US
Mailing Address - Phone:407-780-4132
Mailing Address - Fax:
Practice Address - Street 1:2850 E OSCEOLA PKWY
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34743-6027
Practice Address - Country:US
Practice Address - Phone:407-552-0036
Practice Address - Fax:407-552-0037
Is Sole Proprietor?:No
Enumeration Date:2019-10-31
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS40538183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist