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General NPI Number Information
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NPI Number | 1043526965
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Entity Type | Organization
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Legal Business Name | LUCKY PHARMS INC
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Dates
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Enumeration Date | 08/30/2010
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Last Update Date | 07/09/2012
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Provider Practice Location Address
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Address Line | 375 NE 54TH ST SUITE 3
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City | MIAMI
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State | FL
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Zip | 33137-2967
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Country | US
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Telephone | 305-762-5521
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Fax | 305-433-4113
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Provider Business Mailing Address
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Address Line | 375 NE 54TH ST SUITE 3
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City | MIAMI
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State | FL
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Zip | 33137-2967
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Country | US
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Telephone | 305-762-5521
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Fax | 305-433-4113
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | CARMEN VASQUEZ
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Credential |
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Telephone | 305-762-5521
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PH24825
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License Number State | FL
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