Healthcare Provider Details

I. General information

NPI: 1386939072
Provider Name (Legal Business Name): YOUTH PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2011
Last Update Date: 02/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10788 SW 24TH ST
MIAMI FL
33165-2499
US

IV. Provider business mailing address

10788 SW 24TH ST
MIAMI FL
33165-2499
US

V. Phone/Fax

Practice location:
  • Phone: 305-220-2848
  • Fax: 305-220-2849
Mailing address:
  • Phone: 305-220-2848
  • Fax: 305-220-2849

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH25480
License Number StateFL

VIII. Authorized Official

Name: MR. MAXIMO E GUILLEN
Title or Position: PRESIDENT
Credential:
Phone: 305-220-2848