Healthcare Provider Details

I. General information

NPI: 1356543391
Provider Name (Legal Business Name): ALPHA PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2007
Last Update Date: 05/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7652 N NOB HILL RD
TAMARAC FL
33321-1869
US

IV. Provider business mailing address

7652 N NOB HILL RD
TAMARAC FL
33321-1869
US

V. Phone/Fax

Practice location:
  • Phone: 954-721-1259
  • Fax: 954-721-1346
Mailing address:
  • Phone: 954-721-1259
  • Fax: 954-721-1346

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH22672
License Number StateFL

VIII. Authorized Official

Name: MR. ALFREDO MARTINEZ
Title or Position: OWNER
Credential:
Phone: 954-721-1259