Healthcare Provider Details

I. General information

NPI: 1619490356
Provider Name (Legal Business Name): CLA PHARMACY GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2017
Last Update Date: 01/09/2021
Certification Date: 01/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5240 GOLDEN GATE PKWY
NAPLES FL
34116-7670
US

IV. Provider business mailing address

5240 GOLDEN GATE PKWY
NAPLES FL
34116-7670
US

V. Phone/Fax

Practice location:
  • Phone: 239-241-2864
  • Fax: 239-234-5489
Mailing address:
  • Phone: 239-241-2864
  • Fax: 239-234-5489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH30776
License Number StateFL

VIII. Authorized Official

Name: DEYSI IGLESIAS
Title or Position: OWNER
Credential:
Phone: 239-234-6835