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General NPI Number Information
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NPI Number | 1174840581
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Entity Type | Organization
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Legal Business Name | PALM PHARMACY
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Dates
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Enumeration Date | 04/24/2010
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Last Update Date | 03/04/2013
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Provider Practice Location Address
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Address Line | 486 PALM AVE
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City | HIALEAH
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State | FL
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Zip | 33010-4718
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Country | US
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Telephone | 305-392-0051
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Fax | 305-392-0052
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Provider Business Mailing Address
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Address Line | 486 PALM AVE
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City | HIALEAH
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State | FL
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Zip | 33010-4718
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Country | US
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Telephone | 305-392-0051
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Fax | 305-392-0052
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | JORGE CALERA
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Credential |
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Telephone | 786-262-3007
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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 | PH24542
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License Number State | FL
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