Healthcare Provider Details

I. General information

NPI: 1528508132
Provider Name (Legal Business Name): PASTEUR PHARMACY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2017
Last Update Date: 03/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4544 W 12TH AVE
HIALEAH FL
33012-3325
US

IV. Provider business mailing address

4544 W 12TH AVE
HIALEAH FL
33012-3325
US

V. Phone/Fax

Practice location:
  • Phone: 305-828-3388
  • Fax: 305-823-4161
Mailing address:
  • Phone: 305-828-3388
  • Fax: 305-823-4161

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number607583
License Number StateFL

VIII. Authorized Official

Name: IVAN PEREZ
Title or Position: PHARMACYQUALITY ANALYST
Credential:
Phone: 305-448-8100