=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366197436
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CONFIDENTIAL PHARMA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/17/2022
-----------------------------------------------------
Last Update Date | 02/28/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 645 W HALLANDALE BEACH BLVD STE 107
-----------------------------------------------------
City | HALLANDALE BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33009-5345
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-570-1933
-----------------------------------------------------
Fax | 305-570-2433
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 645 W HALLANDALE BEACH BLVD STE 107
-----------------------------------------------------
City | HALLANDALE BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33009-5345
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-570-1933
-----------------------------------------------------
Fax | 305-570-2433
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHARMACIST IN CHARGE
-----------------------------------------------------
Name | IVETTE SOTO
-----------------------------------------------------
Credential | RPH
-----------------------------------------------------
Telephone | 305-467-4868
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------