Healthcare Provider Details

I. General information

NPI: 1184597874
Provider Name (Legal Business Name): DAVID EDUARDO LORA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2025
Last Update Date: 09/29/2025
Certification Date: 09/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8765 S DIXIE HWY
PINECREST FL
33156-1111
US

IV. Provider business mailing address

14702 SW 42ND WAY
MIAMI FL
33185-4300
US

V. Phone/Fax

Practice location:
  • Phone: 305-740-6840
  • Fax:
Mailing address:
  • Phone: 305-989-3237
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberRPT105392
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: