Healthcare Provider Details

I. General information

NPI: 1972514511
Provider Name (Legal Business Name): SOUTH PARK PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 07/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7035 SW 87TH AVE
MIAMI FL
33173-2505
US

IV. Provider business mailing address

7035 SW 87TH AVE
MIAMI FL
33173-2505
US

V. Phone/Fax

Practice location:
  • Phone: 305-271-3081
  • Fax: 305-271-0226
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH21931
License Number StateFL

VIII. Authorized Official

Name: MARIA ALVAREZ
Title or Position: PRESIDENT
Credential:
Phone: 305-803-3608