Provider Demographics
NPI:1124806328
Name:LATIF, JUSTINE MARIE (PHARMD, BCACP)
Entity type:Individual
Prefix:
First Name:JUSTINE
Middle Name:MARIE
Last Name:LATIF
Suffix:
Gender:F
Credentials:PHARMD, BCACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2917 S GREENLEAF CIR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-8662
Mailing Address - Country:US
Mailing Address - Phone:972-822-8372
Mailing Address - Fax:
Practice Address - Street 1:8645 BOYNTON BEACH BLVD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33472-4415
Practice Address - Country:US
Practice Address - Phone:561-737-6336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS570921835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care