Provider Demographics
NPI:1811629934
Name:MADUKA, CLETUS M (PHARMD)
Entity Type:Individual
Prefix:
First Name:CLETUS
Middle Name:M
Last Name:MADUKA
Suffix:
Gender:M
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:PO BOX 823821
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33082-3821
Mailing Address - Country:US
Mailing Address - Phone:305-216-4545
Mailing Address - Fax:
Practice Address - Street 1:3085 W 80TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-3888
Practice Address - Country:US
Practice Address - Phone:305-863-4277
Practice Address - Fax:305-735-7484
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-28
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS24941183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist