Provider Demographics
NPI:1285246314
Name:REDDIE, DENIQUE (PHARMD)
Entity type:Individual
Prefix:MS
First Name:DENIQUE
Middle Name:
Last Name:REDDIE
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 1:1213 PALM BAY RD
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32905-3781
Mailing Address - Country:US
Mailing Address - Phone:321-676-4602
Mailing Address - Fax:321-676-0536
Practice Address - Street 1:1213 PALM BAY RD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32905-3781
Practice Address - Country:US
Practice Address - Phone:321-676-4602
Practice Address - Fax:321-676-0536
Is Sole Proprietor?:No
Enumeration Date:2020-08-19
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS51191183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist