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General NPI Number Information
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NPI Number | 1285793828
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Entity Type | Organization
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Legal Business Name | PALM LAKES PHARMACY, INC.
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Dates
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Enumeration Date | 12/08/2006
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Last Update Date | 11/05/2008
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Provider Practice Location Address
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Address Line | 3300 W 84TH ST BAY #3
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City | HIALEAH
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State | FL
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Zip | 33018-4903
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Country | US
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Telephone | 305-823-2885
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Fax | 305-823-2890
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Provider Business Mailing Address
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Address Line | 3300 W 84TH ST BAY #3
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City | HIALEAH
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State | FL
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Zip | 33018-4903
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Country | US
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Telephone | 305-823-2885
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Fax | 305-823-2890
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. ROSALIA DEYSI PEREZ
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Credential |
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Telephone | 305-823-2885
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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 | APPLIED FOR
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License Number State | FL
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