Provider Demographics
NPI:1841425923
Name:ROEBUCK, LATRICE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LATRICE
Middle Name:
Last Name:ROEBUCK
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 1:2640 HOLLYWOOD BLVD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-4852
Mailing Address - Country:US
Mailing Address - Phone:786-210-0861
Mailing Address - Fax:
Practice Address - Street 1:2640 HOLLYWOOD BLVD
Practice Address - Street 2:SUITE 209
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-4852
Practice Address - Country:US
Practice Address - Phone:954-367-3843
Practice Address - Fax:954-589-0083
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-19
Last Update Date:2012-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS416951835P0018X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy