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General NPI Number Information
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NPI Number | 1265162820
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Entity Type | Organization
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Legal Business Name | PENATE PHARMACY LLC
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Dates
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Enumeration Date | 06/15/2022
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Last Update Date | 06/15/2022
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Provider Practice Location Address
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Address Line | 995 N MIAMI BEACH BLVD
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City | NORTH MIAMI BEACH
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State | FL
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Zip | 33162-3721
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Country | US
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Telephone | 786-272-9170
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Fax |
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Provider Business Mailing Address
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Address Line | 8200 SW 117TH AVE STE 112
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City | MIAMI
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State | FL
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Zip | 33183-4825
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Country | US
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Telephone | 786-272-9170
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Fax |
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Authorized Official
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Title or Position | MGRM
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Name | LUIS PENATE
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Credential | MD
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Telephone | 786-272-9170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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