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General NPI Number Information
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NPI Number | 1073112116
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Entity Type | Organization
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Legal Business Name | HL72 LLC
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Dates
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Enumeration Date | 10/20/2020
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Last Update Date | 10/20/2020
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Provider Practice Location Address
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Address Line | 5193 CLARK RD
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City | SARASOTA
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State | FL
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Zip | 34233-3213
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Country | US
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Telephone | 973-479-8032
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Fax |
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Provider Business Mailing Address
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Address Line | 5618 NECTAR CV
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City | BRADENTON
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State | FL
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Zip | 34211-4085
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Country | US
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Telephone | 973-479-8032
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Fax |
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Authorized Official
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Title or Position | RPH MGR
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Name | LAILA ABOUZEID
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Credential | PHARM D
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Telephone | 973-479-8032
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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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