Provider Demographics
NPI:1619286036
Name:ROQUE, LAIDYS (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LAIDYS
Middle Name:
Last Name:ROQUE
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 1:4040 SW 84TH TER
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-2951
Mailing Address - Country:US
Mailing Address - Phone:954-701-4496
Mailing Address - Fax:954-236-6988
Practice Address - Street 1:4040 SW 84TH TER
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-2951
Practice Address - Country:US
Practice Address - Phone:954-701-4496
Practice Address - Fax:954-236-6988
Is Sole Proprietor?:No
Enumeration Date:2010-10-03
Last Update Date:2010-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS41378183500000X
FLPU6357183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist