Healthcare Provider Details

I. General information

NPI: 1578919767
Provider Name (Legal Business Name): HEPRO.US INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2016
Last Update Date: 07/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 E 10TH CT
HIALEAH FL
33010-5150
US

IV. Provider business mailing address

325 E 10TH CT
HIALEAH FL
33010-5150
US

V. Phone/Fax

Practice location:
  • Phone: 305-887-5977
  • Fax:
Mailing address:
  • Phone: 305-887-5977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code332100000X
TaxonomyDepartment of Veterans Affairs (VA) Pharmacy
License Number
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateFL

VIII. Authorized Official

Name: DR. KHALED ELHAGE
Title or Position: PURCHASE MANAGER
Credential:
Phone: 786-610-8781