Healthcare Provider Details

I. General information

NPI: 1922377993
Provider Name (Legal Business Name): NEW LIFE COMMUNITY PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2011
Last Update Date: 02/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3032 NW 7TH AVE
MIAMI FL
33127-3624
US

IV. Provider business mailing address

3032 NW 7TH AVE
MIAMI FL
33127-3624
US

V. Phone/Fax

Practice location:
  • Phone: 786-360-4020
  • Fax: 786-334-5385
Mailing address:
  • Phone: 786-360-4020
  • Fax: 786-334-5385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH27113
License Number StateFL

VIII. Authorized Official

Name: JUAN CARLOS CORREA
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 786-360-4020