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General NPI Number Information
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NPI Number | 1205281458
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Entity Type | Organization
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Legal Business Name | LINCOLN PHARMACY LLC
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Dates
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Enumeration Date | 04/25/2016
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Last Update Date | 04/25/2016
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Provider Practice Location Address
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Address Line | 21011 JOHNSON ST SUITE# 126
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-1913
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Country | US
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Telephone | 954-534-9161
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Fax | 800-765-2524
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Provider Business Mailing Address
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Address Line | 21011 JOHNSON ST SUITE# 126
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-1913
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Country | US
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Telephone | 954-534-9161
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Fax | 800-765-2524
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | DR. ILEANA SOTO
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Credential | PHARMD
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Telephone | 954-534-9161
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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 | PH29825
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License Number State | FL
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