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General NPI Number Information
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NPI Number | 1073919718
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Entity Type | Organization
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Legal Business Name | SAN JUDAS PHARMACY CORP
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Dates
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Enumeration Date | 11/07/2014
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Last Update Date | 11/07/2014
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Provider Practice Location Address
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Address Line | 2604 W 84TH ST
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City | HIALEAH
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State | FL
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Zip | 33016-5703
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Country | US
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Telephone | 305-603-7145
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Fax | 786-518-3496
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Provider Business Mailing Address
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Address Line | 2604 W 84TH ST
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City | HIALEAH
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State | FL
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Zip | 33016-5703
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Country | US
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Telephone | 305-603-7145
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Fax | 786-518-3496
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Authorized Official
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Title or Position | PRESIDENT/SECRETARY
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Name | PURO NARANJO
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Credential |
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Telephone | 305-603-7145
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | 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 | 3336S0011X
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Taxonomy Name | Specialty Pharmacy
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License Number | PH28699
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License Number State | FL
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