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General NPI Number Information
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NPI Number | 1316353980
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Entity Type | Organization
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Legal Business Name | LUCKY RX PHARMACY INC
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Dates
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Enumeration Date | 07/03/2014
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Last Update Date | 07/03/2014
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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
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Country | US
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Telephone | 786-317-7216
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Fax |
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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
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | MISS LOURDES PAZ
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Credential |
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Telephone | 786-317-7216
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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 | PH28272
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License Number State | FL
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