Healthcare Provider Details

I. General information

NPI: 1730933607
Provider Name (Legal Business Name): HEPHAESTUS PHARMACEUTICALS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2024
Last Update Date: 04/17/2024
Certification Date: 04/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10913 NW 30TH ST STE 102
DORAL FL
33172-5029
US

IV. Provider business mailing address

10913 NW 30TH ST STE 102
DORAL FL
33172-5029
US

V. Phone/Fax

Practice location:
  • Phone: 888-648-1134
  • Fax: 786-373-1531
Mailing address:
  • Phone: 888-648-1134
  • Fax: 786-373-1531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: NGON-VINCENT VAN
Title or Position: PHARMACIST IN CHARGE
Credential: PHARM.D.
Phone: 888-648-1134