Healthcare Provider Details

I. General information

NPI: 1043614217
Provider Name (Legal Business Name): STAYWELL RX PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2014
Last Update Date: 07/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7209 CORAL WAY
MIAMI FL
33155-1401
US

IV. Provider business mailing address

7209 CORAL WAY
MIAMI FL
33155-1401
US

V. Phone/Fax

Practice location:
  • Phone: 305-262-8297
  • Fax: 305-262-8299
Mailing address:
  • Phone: 305-262-8297
  • Fax: 305-262-8299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH28634
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: AMARILYS ESTOPINAN
Title or Position: OWNER
Credential:
Phone: 305-262-8297