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General NPI Number Information
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NPI Number | 1053664268
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Entity Type | Organization
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Legal Business Name | PRESTIAGE PHARMACY AND MEDICAL SUPPLIES INC
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Dates
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Enumeration Date | 10/25/2012
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Last Update Date | 10/25/2012
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Provider Practice Location Address
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Address Line | 2150 W 76TH ST SUITE 106
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City | HIALEAH
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State | FL
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Zip | 33016-1882
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Country | US
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Telephone | 305-558-3848
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Fax | 305-558-3849
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Provider Business Mailing Address
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Address Line | 2150 W 76TH ST SUITE 106
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City | HIALEAH
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State | FL
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Zip | 33016-1882
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Country | US
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Telephone | 305-558-3848
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Fax | 305-558-3849
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Authorized Official
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Title or Position | PRESSIDENT
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Name | MRS. IDANIA ENRIQUE
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Credential |
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Telephone | 305-558-3848
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number | PH24585
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License Number State | FL
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