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General NPI Number Information
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NPI Number | 1255410353
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Entity Type | Organization
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Legal Business Name | LAS OLAS CHEMIST
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Dates
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Enumeration Date | 11/02/2006
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Last Update Date | 11/11/2024
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Provider Practice Location Address
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Address Line | 1211 EAST LAS OLAS BLVD
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City | FT. LAUDERDALE
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State | FL
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Zip | 33301-2331
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Country | US
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Telephone | 954-462-4166
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Fax | 954-462-4186
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Provider Business Mailing Address
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Address Line | 1211 EAST LAS OLAS BLVD
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City | FT. LAUDERDALE
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State | FL
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Zip | 33301-2331
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Country | US
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Telephone | 954-462-4166
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Fax | 954-462-4186
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. MARC LEACH
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Credential | RPH
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Telephone | 954-462-4166
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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 | PH19947
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License Number State | FL
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