Basic Information
| Provider Information | |||||||||
| NPI: | 1205479086 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CULMER | ||||||||
| FirstName: | VALENCIA | ||||||||
| MiddleName: | |||||||||
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| Credential: | RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2828 SW 130TH TER | ||||||||
| Address2: | |||||||||
| City: | MIRAMAR | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330273856 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9544489530 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3791 NW 167TH ST | ||||||||
| Address2: | |||||||||
| City: | MIAMI GARDENS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330554510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3059141974 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2019 | ||||||||
| LastUpdateDate: | 10/23/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | PS32100 | FL | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.