Healthcare Provider Details

I. General information

NPI: 1760707806
Provider Name (Legal Business Name): 305 RX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2010
Last Update Date: 03/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

344 W 65TH ST STE 101
HIALEAH FL
33012-6719
US

IV. Provider business mailing address

344 W 65TH ST #101
HIALEAH FL
33012-6719
US

V. Phone/Fax

Practice location:
  • Phone: 305-558-3522
  • Fax: 305-487-7409
Mailing address:
  • Phone: 305-558-3522
  • Fax: 305-487-7409

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH24536
License Number StateFL

VIII. Authorized Official

Name: VICTOR HERNANDEZ
Title or Position: OWNER
Credential:
Phone: 305-558-3522