Provider Demographics
NPI:1699261578
Name:OSBOURNE, ALVANETA
Entity type:Individual
Prefix:
First Name:ALVANETA
Middle Name:
Last Name:OSBOURNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 NW 139TH TER
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-2340
Mailing Address - Country:US
Mailing Address - Phone:954-240-8481
Mailing Address - Fax:
Practice Address - Street 1:3948 PEMBROKE RD STE D
Practice Address - Street 2:
Practice Address - City:PEMBROKE PARK
Practice Address - State:FL
Practice Address - Zip Code:33021-8114
Practice Address - Country:US
Practice Address - Phone:954-240-8481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-03
Last Update Date:2024-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS33976183500000X, 1835P0018X
FL174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No174H00000XOther Service ProvidersHealth Educator
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist