=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346677093
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SONIC PHARMACY INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2013
-----------------------------------------------------
Last Update Date | 09/26/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 112 N HOMESTEAD BLVD
-----------------------------------------------------
City | HOMESTEAD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33030-7426
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-527-8399
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 112 N HOMESTEAD BLVD
-----------------------------------------------------
City | HOMESTEAD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33030-7426
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-527-8399
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | CARLOS HERNANDEZ
-----------------------------------------------------
Credential | PRESINDENT
-----------------------------------------------------
Telephone | 305-527-8399
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number | PH26370
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------