Healthcare Provider Details

I. General information

NPI: 1437148830
Provider Name (Legal Business Name): VACRUZ INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3305 E 4TH AVE
HIALEAH FL
33013-3005
US

IV. Provider business mailing address

3305 E 4TH AVE
HIALEAH FL
33013-3005
US

V. Phone/Fax

Practice location:
  • Phone: 305-836-9964
  • Fax: 305-836-2050
Mailing address:
  • Phone: 305-836-9964
  • Fax: 305-836-2050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH3009
License Number StateFL

VIII. Authorized Official

Name: MR. ELIU MOLINER
Title or Position: OWNER
Credential:
Phone: 305-836-9964