Provider Demographics
NPI:1992560775
Name:BRATHWAITE, CAPTAIN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:CAPTAIN
Middle Name:
Last Name:BRATHWAITE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3165 SW 67TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-4820
Mailing Address - Country:US
Mailing Address - Phone:954-549-7456
Mailing Address - Fax:
Practice Address - Street 1:14306 7TH ST
Practice Address - Street 2:
Practice Address - City:DADE CITY
Practice Address - State:FL
Practice Address - Zip Code:33523-3434
Practice Address - Country:US
Practice Address - Phone:352-567-2238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-20
Last Update Date:2024-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS65987183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist