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General NPI Number Information
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NPI Number | 1083789440
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Entity Type | Organization
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Legal Business Name | ELY'S PHARMACY AND DISCOUNT CORP.
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 15126 SW 56TH ST
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City | MIAMI
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State | FL
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Zip | 33185-4072
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Country | US
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Telephone | 305-385-7770
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Fax |
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Provider Business Mailing Address
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Address Line | 15126 SW 56TH ST
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City | MIAMI
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State | FL
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Zip | 33185-4072
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Country | US
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Telephone | 305-385-7770
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Fax |
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Authorized Official
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Title or Position | OWNER-PHARMACIST MANAGER
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Name | MRS. ELIZABETH RUIZ LOPEZ
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Credential |
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Telephone | 305-385-7770
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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 | PH21185
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License Number State | FL
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