Healthcare Provider Details

I. General information

NPI: 1205168804
Provider Name (Legal Business Name): ALFREDNEV CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2010
Last Update Date: 07/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 NW 183RD ST SUITE #103
MIAMI GARDENS FL
33169-4545
US

IV. Provider business mailing address

180 NW 183RD ST SUITE #103
MIAMI GARDENS FL
33169-4545
US

V. Phone/Fax

Practice location:
  • Phone: 305-654-7859
  • Fax: 305-654-5336
Mailing address:
  • Phone: 305-654-7859
  • Fax: 305-654-5336

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH24440
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: NEVILLE THOMPSON
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 305-654-7859