Provider Demographics
NPI:1124785829
Name:JEAN-LOUIS, MICHTTA (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MICHTTA
Middle Name:
Last Name:JEAN-LOUIS
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 1:4361 NW 25TH ST
Mailing Address - Street 2:
Mailing Address - City:LAUDERHILL
Mailing Address - State:FL
Mailing Address - Zip Code:33313-3622
Mailing Address - Country:US
Mailing Address - Phone:954-708-5054
Mailing Address - Fax:
Practice Address - Street 1:4400 HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6610
Practice Address - Country:US
Practice Address - Phone:954-987-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-17
Last Update Date:2021-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS60801183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist